Early pleural effusions related to the myocardial injury after open-heart surgery for congenital heart disease.
OBJECTIVE
The degree of effusion immediately after cardiopulmonary bypass (CPB) can vary and may reflect several factors including the degree of myocardial injury. We compared the degree of pleural effusions after CPB to the overall myocardial injury as determined by serum cardiac troponin I (cTnI) levels after elective repair of a variety of congenital heart defects, including univentricular surgeries via cavopulmonary shunts.


METHODS
Serum was collected pre-CPB, post-CPB, and daily after that and cTnI level measured. The postoperative pleural effusion was measured each day until the chest tube was removed. Results. The 21 study patients were of average age of 5.5 years (+/-5.6). The duration of chest-tube drainage after open-heart surgery was 4.3 days (+/-3.5) and the amount was 2.4 mL/kg/hour (+/-2.9). For the biventricular repairs, cTnI levels on the postoperative day (POD) 1 best correlated with amount of effusion (n = 16, r = 0.5, P = 0.02) and the average (POD 0-3) cTnI levels with the total duration (n = 16, r = 0.4, P = 0.01) and also the amount (n = 16, r = 0.5, P = 0.02) of effusions. For the cavopulmonary shunts, the post-CBP cTnI level best correlated with the duration (n = 5, r = 0.8, P = 0.02) and amount (n = 5, r = 0.9, P = 0.02) of effusions. A cTnI level on the first postoperative day >or=15 microg/L was associated with effusions >2 days (sensitivity of 81% and specificity of 80%).


CONCLUSIONS
We found that higher the cTnI released, especially >or=15 microg/L, longer the duration and greater the amount of early pleural effusions for a variety of congenital heart surgeries including cavopulmonary shunts. A number of factors may lead to excessive pleural effusions and the degree of myocardial injury may be one of them.
Gupta-Malhotra
Monesha
M
Division of Pediatric Cardiology, The New York Presbyterian Hospital, Weill Medical College of Cornell University and College of Physicians and Surgeons of Columbia University, New York, USA. monesha.gupta@uth.tmc.edu
Kern
Jeffrey H
JH
Flynn
Patrick A
PA
Schiller
Myles S
MS
Quaegebeur
Jan M
JM
Friedman
Deborah M
DM
D000293:Adolescent; D015415:Biomarkers / Q000097:blood; D006348:Cardiac Surgical Procedures / Q000009:adverse effects*; D002315:Cardiopulmonary Bypass / Q000009:adverse effects; D015505:Chest Tubes; D002648:Child; D002675:Child, Preschool; D004322:Drainage / Q000295:instrumentation; D017558:Elective Surgical Procedures; D005260:Female; D006330:Heart Defects, Congenital / Q000097:blood / Q000503:physiopathology / Q000601:surgery*; D006331:Heart Diseases / Q000097:blood / Q000209:etiology* / Q000473:pathology / Q000503:physiopathology; D006439:Hemodynamics; D006801:Humans; D008297:Male; D009206:Myocardium / Q000378:metabolism / Q000473:pathology*; D009519:New York City; D010996:Pleural Effusion / Q000209:etiology*; D011237:Predictive Value of Tests; D011446:Prospective Studies; D013997:Time Factors; D016896:Treatment Outcome; D019210:Troponin I / Q000097:blood; D055815:Young Adult
D015415:Biomarkers; D019210:Troponin I