Circulation Journal Official Journal of the Japanese Circulation Society http://www. j-circ.or.jp ardiac surgery with or without cardiopulmonary bypass (CPB) induces a marked and persistent depression of circulating thyroid hormones during the postoperative period both in adults and in children. 1-9Postoperative thyroid hormone levels are proposed as lowcost, adjunctive prognostic markers in children undergoing cardiac surgery for congenital heart disease (CHD). 2,4,5,10,11 In particular, the degree of hypothyroxinemia reached after surgery is related to important clinical endpoints in pediatric cardiac surgery including the duration of mechanical ventilation, 3,4,6 intensive care treatment 3,10 and the degree of inotropic support. 4,5The growing interest in thyroidal response after cardiac surgery is even more justified by the potentially dangerous effects of a hypothyroid-like condition with decreased heart rate, cardiac output, and increased systemic vascular resistance. 2 Preoperative and postoperative brain natriuretic peptide (BNP) or NT-pro-BNP values are also useful markers of postoperative outcome in children with CHD. 12-18 Higher BNP values are associated with the duration of mechanical ventilation, intensive care unit (ICU) stay, the need for inotropic support and low cardiac output syndrome 12-18 and composite endpoint. 12 Many aspects of thyroid and BNP response after pediatric cardiac surgery still remain undefined. In particular, the effect Background: Interest in hormonal response after pediatric cardiac surgery is growing, but many aspects remain unclear. The aim of this study was to test age-related variations and prognostic values of thyroid hormones, and brain natriuretic peptide (BNP) levels before and after surgery.