Effect of oral l-carnitine on hepatic function in pediatric patients under repair of congenital cardiac defect.

BACKGROUND

l-carnitine, with anti-inflammatory and antioxidant properties, may help prevent liver damage caused by factors including hypoxia, hemodynamic instability, heparin-protamine reactions, and transfusion-related complications. This study evaluates the effect of preoperative oral l-carnitine on liver function in pediatric patients undergoing congenital heart disease repair.

METHODS

This randomized, double-blind clinical trial assessed l-carnitine's impact on liver function in children aged 6-60 months after cardiac surgery for congenital heart defects. All patients underwent on-pump cardiac surgery following a standardized institutional protocol, including systemic heparinization (300 IU/kg) prior to cardiopulmonary bypass and reversal with protamine sulfate post-bypass (1 mg per 100 IU of heparin). Blood transfusion was guided by intraoperative hemoglobin levels (<8 g/dL threshold). Re-exploration criteria included ongoing hemodynamic instability, chest drainage >5 mL/kg/h for >3 hours, or evidence of tamponade on echocardiography.

RESULTS

A total of 60 patients participated in the study, the l-carnitine group showed a faster recovery in liver function, with significantly lower aspartate aminotransferase (AST) levels by day 7 compared to the control group. Alanine aminotransferase and lactate dehydrogenase levels were higher in the l-carnitine group at baseline but evened out over time. Alkaline phosphatase levels were significantly higher in the l-carnitine group by day 7. The l-carnitine group also had lower indirect bilirubin levels by day 7, suggesting improved liver recovery.

CONCLUSION

The findings suggest that l-carnitine may aid liver recovery and affect specific biochemical markers in pediatric patients following surgery. This points to its potential therapeutic role in enhancing recovery outcomes in this group.