The Effect of Oral Triiodothyronine in Outcome of Pediatric Congenital Cardiac Surgery

Background: Cardiac surgery especially in small children is associated with a marked decrease in thyroid hormone levels consistent with the phenomenon referred to as Sick Euthyroid Syndrome (SES). The purpose of the present study was to determine if oral triiodothyronine could reduce the length of ICU stay, vasoactive inotropic score (VIS), and promote ejection fraction in infants and children undergoing cardiac surgery with CPB. Materials and Methods: In a double-blind clinical trial, one hundred and twenty children aged 6 to 60 months and scheduled for different types of cardiac surgery with CPB, were randomized into two groups to receive either 2 mcg/Kg triiodothyronine (trial group) or 5% dextrose water (placebo group), immediately after anesthesia and 24 hours after surgery. The perioperative serum thyroid hormone levels and hemodynamic variables were determined. The intubation time, ICU stay length, ICU inotropic use, and cardiac ejection fraction was recorded. Results: The basic demographic data were comparable in two groups. No significant side effects or adverse reactions were seen due to hormone therapy. Intubation time, ICU stay, and VIS values were significantly shorter between the two groups. Conclusion: In children undergoing cardiac surgery with CPB, perioperative oral small-dose triiodothyronine therapy could improve clinical indices of perioperative care

Effect of combined Conventional Ultrafiltration and Modified Ultrafiltration on Serum Interleukin-6 and TNF-α Levels in Pediatric Cardiac Surgery Patients

AbstractBackground: Water retention occurs in most of the congenital heart surgery patients, especially in pediatrics. Ultrafiltration excretes water, electrolytes, many free radicals and inflammatory mediators. The aim of this study was to investigate the effect of modified ultrafiltration (MUF) on the serum levels of TNF-α and IL-6 in pediatrics patients undergoing congenital heart surgeries.Methods and Materials: A total of 91 pediatric congenital heart disease patients candidate for total correction were selected and divided randomly in two groups: CUF (Conventional Ultrafiltration) and CUF+MUF; 40 patients were allocated to CUF group and 51 patients to CUF+MUF group. Serum levels of TNF-α and IL-6 were assessed before CPB and 6 hours after the end of the operation in ICU. Postoperative levels of TNF-α and IL-6 were compared between the two groups.Results: In the MUF+CUF group, the preoperative and postoperative TNF-α levels were 2.5±5.6 and 1.4±3.0 respectively. However, IL-6 serum levels before and after operation were 4.8±8.9 and 41±56. In the CUF only group, the TNF-α level before and after surgery was 3.1±6.2 and 1.0±0.44; respectively; similarly, IL-6 serum levels were 3.3±8.2 and 34.8±37.7.Conclusion: MUF in congenital heart surgery could filtrate excess water and elevate hematocrit but does not have a definitive role in reducing TNF-α and IL-6 serum levels.Keywords: MUF, TNF-α, IL-6, CUF, cardiopulmonary bypas

Device-Induced Perforation of Right Atrium Following Interventional Closure of Atrial Septal Defect (ASD)

This is a case presentation of a 26-year-old woman with a moderate-sized atrial septal secundum defect (17mm) who underwent catheterism, during which an Amplatzer Septal Occluder number 26 was inserted successfully. On the second postoperative day, she deteriorated and a clinical examination showed a typical tamponade. After a percutaneous aspiration of the pericardial cavity and transient improvement in vital signs, a pig-tail catheter was inserted percutaneously emergently, and the patient was transferred to the operating room in a preshock state. During the operation, an active bleeding point in the superoanterior aspect of the right atrium near the aortic root was detected, which was repaired by direct suture and pericardial patch reinforcement. The Amplatzer device was removed and the atrial septal defect was repaired with a pericardial patch. A lethal complication of the interventional closure of atrial septal defect, properly treated by an emergent intervention and operation, is presented and discussed herein

Inflammatory myofibroblastic tumor of the pericardium in an 11‐month‐old infant: A case report

Abstract Primary cardiac tumors are very rare in infants. Here we present an 11‐month‐old infant with a pericardial inflammatory myofibroblastic tumor who presented with symptoms of respiratory distress and cardiac tamponade. The tumor was surgically removed, and the patient received medical treatment; the patient had no problem with follow‐up