Kardiyopulmoner Bypass Kullanılarak Açık Kalp Cerrahisi Yapılan Pediatrik Konjenital Kalp Hastalarında Preoperatif ve Postoperatif Serum Tiroid Hormon Profili ve Postoperatif Sonuçlara Etkileri

Abstract

After open heart surgery with cardiopulmonary bypass in patients with congenital heart disease who does not have thyroid function abnormalities, postoperative levels of serum thyroid hormones are found to be decreased. This condition is called euthyroid sick syndrome. The decrease of serum levels of thyroid hormones may have a negative impact on postoperative results. We studied 55 pediatric patients who had cardiac surgery with cardiopulmonary bypass in the Department of Cardiovascular Surgery in Hacettepe University School of Medicine. We evaluated the relationship between postoperative levels of serum thyroid hormones and their effects on postoperative outcomes. In order not to affect results; patients older than 18 years were excluded. Patients were separated into 2 groups. The group with patients who did not receive inotropic support was called Group 1 and the other group with patients who received inotropic support was called Group 2. Blood samples were drawn preoperatively and in 1th, 24th, 48th, 72nd hours postoperatively. Free triiodotironin (FT3), free tiroxin (FT4), thyroid stimulating hormone (TSH), total triiodotironin (TT4) and total tiroxin (TT3) levels were studied for each hours. Preoperative thyroid hormone levels were similar in each group. There were significantly lower postoperative levels of thyroid hormones, when compared with preoperative levels in all groups. In Group 2, serum levels of thyroid hormones were significantly lower than Group 1. Hospital stay and mechanical ventilation duration was significantly longer in Group 2. Cardiopulmonary bypass duration and aortic clamp time was significantly longer in Group 2. The relationship between the decrease of serum levels of thyroid hormones and postoperative outcomes must be considered as an important correlation in clinical management rather than a cause and effect relationship. Postoperative levels of FT4 and especially FT3 had significant correlation between postoperative outcomes such as prolonged mechanical ventilation time and prolonged stay in intensive care unit and hospital. However there was no significant correlation between TT4, TT3, TSH and postoperative outcomes.