ISSN:
1540-8191
Source:
Blackwell Publishing Journal Backfiles 1879-2005
Topics:
Medicine
Notes:
Objectives: A prospective study to evaluate pathology-related differences in cardiac troponin I (TnI) release and its relation to clinical outcome after paediatric open-heart surgery. Backgound: The degree of perioperative myocardial injury is determined by the ischaemic duration but also by the pathology and preoperative state of the heart (acidosis or cyanosis). Cardiac TnI is a marker of myocardial injury but little is known about the differences in TnI release between different pathologies. Methods: Troponin I was measured in 133 consecutive 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) according to the normal diameter of the pulmonary valve to body weight. Results: There was no mortality. Postoperative TnI levels were lesion-specific and did not correlate with clinical outcome for ASDs (〈link href="#t2"〉Table 1). For VSDs, peak TnI correlated with the durations of inotropic support (r = 0.69, p = 0.0001), ventilation (r = 0.64, p 〈 0.0001) and intensive care unit (ICU) stay (r = 0.60, p 〈 0.0001) with infants (〈1 year old, n = 29) showing higher peak TnI (4.11 ± 0.46 vs 2.49 ± 0.33ng/ml, p = 0.02) and worse clinical outcome than children. For TOF, peak TnI correlated with the duration of inotropic support (r = 0.51, p = 0.0004), ventilation (r = 0.36, p = 0.02) and ICU stay (r = 0.55, p = 0.0001) whereas arterial oxygen saturation showed a negative correlation with these (r =−0.39 to −0.49, p 〈 0.05). Those undergoing an extended RVOT incision had greater peak TnI and worse clincial outcome than those with a minimum RVOT incision (〈link href="#t3"〉Table 2). Conclusions: TnI is a reliable marker of early post-operative recovery after repair of VSDs and TOF. Age (〈1 year) for patients with VSDs and right ventriculotomy length in TOF are important determinants of clinical outcome.〈tabular xml:id="t2"〉1〈title type="main"〉 Patient Characteristics 〈table frame="topbot"〉〈tgroup cols="4" align="left"〉〈colspec colnum="1" colname="col1" align="left"/〉〈colspec colnum="2" colname="col2" align="center"/〉〈colspec colnum="3" colname="col3" align="center"/〉〈colspec colnum="4" colname="col4" align="center"/〉〈thead valign="bottom"〉〈entry morerows="1" valign="top" align="center"〉 ASD (n = 41) 〈entry morerows="1" valign="top" align="center"〉 VSD (n = 46) 〈entry morerows="1" valign="top" align="center"〉 TOF (n = 46) 〈tbody valign="top"〉Age (months) 71.4 ± 6.9 25.3 ± 6.2 18.0 ± 2.9 ACC time (min) 26.4 ± 2.7* 39.2 ± 2.9 49.1 ± 3.6 Inotrope duration (hours) 9.5 ± 1.4* 37.2 ± 6.5 71.6 ± 9.0† Ventilation time (hours) 6.9 ± 1.1
Type of Medium:
Electronic Resource
URL:
http://dx.doi.org/10.1046/j.1540-8191.2002.01014_6.x
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