日本小児循環器学会雑誌 Pediatric Cardiology and Cardiac Surgery

Objective: Carnitine is essential for long-chain fatty acid metabolism in order to produce biological energy via the mitochondria. Carnitine deficiency can result in cardiomyopathy, hypoglycemia, and other complications. This study aimed to determine how plasma carnitine levels changed before and after open-heart surgery with cardiopulmonary bypass (CPB) in children with congenital heart disease.

Methods: We measured free carnitine (C0) levels in the blood before and after CPB, as well as on each day 7 days after the procedure.

Results: We treated 50 patients with average age of 35±49 months. We identified 19 patients with extracardiac complications, including eight with chromosomal disorder, three with suspected chromosomal disorder, four preterm births, two with digestive disorders, and two with other complications. C0 levels immediately before CPB were 55.8±24.4 nmol/mL, whereas immediately after CPB were significantly lower [33.5±12.9 nmol/mL (the ratio of C0 level before and after CPB were: 64±19％, p＜0.01)]. Although there was no significant difference in aortic clamp time, CPB time, or pre-operative blood data, the presence of extracardiac complications was significantly correlated to the C0 level just after CPB (odds ratio, OR: 3.385, 95％ confidence interval, CI: 1.858–3.385, p＜0.01).

Conclusion: C0 dropped temporarily after CPB and then returned three days later. Since the decrease in C0 after CPB was linked to extracardiac complications in children with congenital heart disease, monitoring pre- and post-operative C0 concentration may be warranted in these patients.