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(Circulation. 2000;101:1423.)
© 2000 American Heart Association, Inc.

Clinical Investigation and Reports

Pharmacokinetic Evaluation of Triiodothyronine Supplementation in Children After Modified Fontan Procedure

Richard D. Mainwaring, MD; Edmund Capparelli, PharmD; Kenneth Schell, PharmD; Mark Acosta, PharmD; Jerald C. Nelson, MD

From Nemours Cardiac Center, Alfred I. Dupont Hospital for Children, Wilmington, Del (R.D.M.); Children’s Hospital–San Diego, San Diego, Calif (E.C., K.S., M.A.); and Quest Diagnostics, Nichols Institute, San Juan Capistrano, Calif (J.C.N.).

Correspondence to Richard D. Mainwaring, MD, Alfred I. DuPont Hospital for Children, Nemours Cardiac Center, 1600 Rockland Road, PO Box 269, Wilmington, DE 19899. E-mail rmainwar{at}nemours.org

Background—Triiodothyronine (T₃) supplementation may be a useful adjunct in the management of patients after cardiopulmonary bypass. Limited data are available regarding the use and pharmacokinetics of T₃ in children. The present study was performed to evaluate T₃ pharmacokinetics in a cohort of children undergoing the modified Fontan procedure.

Methods and Results—A total of 28 patients were enrolled in this randomized, prospective study. The patients were divided into 4 groups: 1 group received a placebo and 3 groups received intravenous T₃ at dosages of 0.4, 0.6, and 0.8 µg/kg, respectively. All 28 patients survived their operative procedures. Two patients developed low cardiac output, and 3 patients had pleural effusions. The median length of hospital stay was 7 days. The mean free T₃ level was 316±67 pg/dL after then administration of a placebo. Patients who received T₃ had mean peak free T₃ levels of 972±88, 1351±299, and 1869±281 pg/dL for the dosages of 0.4, 0.6, and 0.8 µg/kg, respectively. The calculated half-life of T₃ was 7 hours.

Conclusions—The half-life of intravenous T₃ in children is approximately one-third of that reported for adults. These results provide a framework for studying the efficacy of T₃ supplementation in children undergoing open-heart surgery.

Key Words: Fontan procedure • heart defects, congenital • pediatrics • cardiopulmonary bypass

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