Thyroid and Brain Natriuretic Peptide Response in Children Undergoing Cardiac Surgery for Congenital Heart Disease

Abstract

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.

Triiodothyronine Activates Lactate Oxidation Without Impairing Fatty Acid Oxidation and Improves Weaning From Extracorporeal Membrane Oxygenation

“…7 Moreover, T3 decreases in children undergoing cardiac surgery for congenital heart disease. 8 A deficit in myocardial stimulation by T3 is known to impair oxidative metabolism and adenosine triphosphate (ATP) synthesis, and affects arterial stiffening and cardiac contractility. 9,10 …”

B‐type natriuretic peptide trends after pediatric heart transplantation

“…It has been previously described that newborns may have differences in “normal” values compared with older children particularly for the first two wk of life . After cardiac surgery, infants have a delayed peak in BNP . These differences could lead to a type 1 error when comparing infants to older children.…”

Biomarkers in congenital heart disease: do natriuretic peptides hold the key?

“…Higher BNP values are associated with severity of illness [87], the duration of mechanical ventilation [88], intensive care unit stay [88], the need for inotropic support [89] and low cardiac output syndrome [88]. Cantinotti et al reported, in 162 children who underwent cardiac surgery, that peak BNP was an independent predictor of time to extubation in older children [90]. However, timing and magnitude of postoperative BNP levels were age-dependent, with a drop in neonates but an increase in older children [90].…”

“…Cantinotti et al reported, in 162 children who underwent cardiac surgery, that peak BNP was an independent predictor of time to extubation in older children [90]. However, timing and magnitude of postoperative BNP levels were age-dependent, with a drop in neonates but an increase in older children [90]. This limits its practical utility as an isolated point-of-care measurement [87].…”