Transient Secondary Hypothyroidism and Thyroid Hormone Replacement Therapy in Pediatric Postoperative Cardiopulmonary Bypass.

BACKGROUND: To develop an understanding of current practices in the management of transient secondary hypothyroidism in pediatric postoperative cardiopulmonary bypass (CPB) patients. METHODS: Electronic survey comprising a 10-item questionnaire was sent to sixty-four high volume pediatric heart centers in the United States and United Kingdom. Survey participants included cardiologists, intensivists, cardiothoracic surgeons, and advanced practice providers. A retrospective chart review was also performed at a large regional referral center in the Midwest on subjects 0-18 years old who underwent CPB from 2005-2015. Information obtained included a unique identifier, date of birth, age, procedure performed, CPB time, date of surgery and date and type of Thyroid Function Test (TFT) ordered. RESULTS: 1,153 individuals from 64 congenital heart centers were contacted via email to participate in the electronic survey. In the 3-month response window, 129 completed surveys were received from cardiologists (55%), intensivists (17%), surgeons (15%), "other" (8%), and advanced practice providers (5%). This yielded a response rate of 11.2%. Of the 129 respondents, only 10 providers routinely order TFTs prior to (n=7) and after (n=1) CPB or when clinically indicated (n=2). All 10 providers order thyroid stimulating hormone test, 7 order thyroxine, and 3 order triiodothyronine. Only 1 provider routinely treats children with prophylactic thyroid hormone replacement therapy after CPB. Our retrospective review included 502 CPB events with 442 unique patients. Of the events, 20 patients received preoperative TFT testing while 11 received postoperative testing. CONCLUSIONS: There is a general lack of uniformity in the evaluation, diagnosis, and treatment of transient secondary hypothyroidism in pediatric postoperative CPB patients.

Biventricular Repair of Pulmonary Atresia After Fontan Palliation.

Fontan palliation is used when biventricular repair (BVR) is not possible. Early outcomes are acceptable; however, the long-term sequelae include protein-losing enteropathy, declining functional status, increased pulmonary vascular resistance, heart failure, and hepatic and renal dysfunction. These adverse events are characteristic of persistent venous hypertension and may be avoided if restoring biventricular circulation is possible. Arrhythmias are a common adverse event, particularly in patients with an atriopulmonary connection, which may lead to acute decompensation and early death. We describe a 30-year-old woman who underwent successful BVR for pulmonary atresia with intact ventricular septum and demonstrate that where favorable anatomy exists with a failing Fontan, BVR should be considered.

Surgical Treatment of Neonate With Congenital Left Main Coronary Artery Atresia.

Left main coronary artery atresia (LMCAA) is a rare congenital malformation with a nonspecific and varied clinical presentation. Ventricular dysfunction and mitral insufficiency are expected ischemic consequences in the neonatal period. Left internal mammary artery (LIMA) bypass grafting (CABG) is uncommon because of the technical difficulties in performing this procedure in neonates. We describe LMCAA revascularization with a LIMA graft and mitral valve repair in a 7-week-old neonate with successful outcome 1 year postoperatively.