Pathology-related troponin I release and clinical outcome after pediatric open heart surgery.
BACKGROUND
Perioperative myocardial injury is determined by the ischemic duration, pathology, and preoperative myocardial status. Our aim was to evaluate pathology-related differences in troponin I (TnI) release, a sensitive and specific marker of myocardial injury, and its relation to clinical outcome after pediatric open heart surgery.


METHODS
Troponin I was measured serially postoperatively in 133 children undergoing repair of atrial (ASD, n = 41) and ventricular septal defects (VSD, n = 46), and tetralogy of Fallot (TOF, n = 46). The length of the right ventricular outflow tract (RVOT) incision in the latter was classified as either minimum(n = 33) or extended(n = 13).


RESULTS
Postoperative TnI levels were lesion specific and did not correlate with clinical outcome for ASDs. Peak TnI correlated with inotropic duration for VSD (r = 0.69, p < 0.0001) and TOF (r = 0.51, p = 0.0004). Significant correlations were also observed for the durations of ventilation (r = 0.64 and 0.36, respectively) and ICU stay (r = 0.60 and 0.55). Younger age (<1 year old) in children with VSDs and an extended incision into the RVOT in TOF were associated with greater TnI release and worse clinical outcome.


CONCLUSIONS
Postoperative TnI release is pathology related and reflects myocardial damage from both ischemia-reperfusion injury and direct myocardial trauma.
Modi
Paul
P
Bristol Heart Institute, University of Bristol, Bristol, UK.
Imura
Hajime
H
Angelini
Gianni D
GD
Pawade
Ash
A
Parry
Andrew J
AJ
Suleiman
M-Saadeh
MS
Caputo
Massimo
M
D002675:Child, Preschool; D006330:Heart Defects, Congenital / Q000378:metabolism* / Q000601:surgery; D006344:Heart Septal Defects, Atrial / Q000378:metabolism / Q000601:surgery; D006345:Heart Septal Defects, Ventricular / Q000378:metabolism / Q000601:surgery; D006352:Heart Ventricles / Q000601:surgery; D006801:Humans; D007223:Infant; D015428:Myocardial Reperfusion Injury / Q000378:metabolism*; D009206:Myocardium / Q000378:metabolism* / Q000473:pathology*; D013771:Tetralogy of Fallot / Q000378:metabolism / Q000601:surgery; D016896:Treatment Outcome; D019210:Troponin I / Q000378:metabolism*
D019210:Troponin I