All issues > Volume 38(11); 1995

Original Article

J Korean Pediatr Soc. 1995;38(11):1540-1546. Published online November 15, 1995.

Ischemic Hepatitis in Children after Cardiac Operation -Analysis of Clinical Characteristics, Risk Factors and Outcome-

Kyung Mo KM Kim¹, Jeong Kee JK Seo¹

¹Department of Pediatrics, Seoul National University College of Medicine, Seoul, Korea

Abstract

Purpose
: We have experienced frequently the ischemic hepatitis after cardiac operations which shows rapid striking rise of transaminase. But the ischemic hepatitis in children after cardiac operation is not defined yet in Korea. We examined the clinical characteristics and analyzed the risk factors and outcome in 20 children who showed typical clinical course of ischemic hepatitis after cardiac operation.
Methods
: We selected 20 children who showed the elevation of transaminase over 1000 IU/L within 48 hours after cardiac operation. The clinical course was examined. To analyze the risk factors, incidence of ischemic hepatitis was assessed according to underlying disease, aortic clamping time, and performance of cardiac arrest, changes in central venous pressure. Outcome was also analyzed.
Results
: The highest GOT levels were noticed on the second day (mean 9,433 IU/L) and recovered within 9th days after cardiac operation. But elevations of serum bilirubin and alkaline phosphatase were not prominent. Twenty children showed elevation of creatinine and six of them required peritoneal dialysis. The duration of aortic clamping time and the execution of cardiac arrest were important precipitating factors in the development of ischemic hepatitis. Although six of them died as a result of sepsis and arrhythmia, none died as a direct result of the liver failure. Those who survived showed restoration of liver function completely.
Conclusion
: According to the above results, it is necessary for us to understand the typical clinical course of ischemic hepatitis to make a correct diagnosis and predict a prognosis. In case of cardiac operation we should make an effort to reduce the risk factors.

Keywords :Ischemic hepatitis, Child, Cardiac operation, Risk factors, Prognosis