Original ArticlesPatterns and Potential Value of Cardiac Troponin I Elevations After Pediatric Cardiac Operations
Section snippets
Patient Population
All patients undergoing elective repair of congenital heart defects requiring cardiopulmonary bypass were prospectively enrolled in the study protocol from January to December 1995. Only patients who had repair of secundum type atrial septal defects (ASD), paramembranous ventricular septal defects (VSD), and tetralogy of Fallot (TOF) were included in this analysis. Other surgical procedures were not analyzed as the numbers in each category were small. To establish baseline cTnI levels in
Patient Population and Outcome Variables
Between January and December 1995, 61 children underwent surgical repair of either an ASD (n = 23), VSD (n = 19), or TOF (n = 19). Six patients with complications were excluded, leaving 55 patients in the study cohort (Table 1). The 6 excluded subjects included 3 with postoperative junctional tachycardia, 2 from the VSD group and 1 from the TOF group. Hemodynamically significant pericardial effusions were diagnosed and drained in 1 patient each from the VSD and TOF groups, and another patient
Comment
Cardiac troponin I is one component of a complex of three separate proteins that, together with tropomysin, confers calcium sensitivity to the process of actin–myosin cross-bridge formation in the myocardial cell. Found exclusively in the myocardial cell, it is a potent inhibitor of those interactions [5]. Assay for cTnI is sensitive and specific, with no detectable cross-reactivity with skeletal muscle troponin. The level of cTnI is a more sensitive index of myocardial cell damage than either
Acknowledgements
We thank Marsha Kuhns for technical assistance. Doctor Ladenson is a consultant to Dade-Behring Corporation (Wilmington, DE).
References (13)
- et al.
Intracardiac surgery in infants under age 3 monthsincremental risk factors for hospital mortality
Am J Cardiol
(1981) - et al.
Plasma creatine kinase isoenzyme in infants and children. Characterization in normal patients and after cardiac catheterization and surgery
Chest
(1980) - et al.
Use of cardiac troponin I as a marker of perioperative myocardial ischemia
Ann Thorac Surg
(1995) - et al.
Improved detection of cardiac contusion with cardiac troponin I
Am Heart J
(1996) - et al.
Cardiac troponin I in pediatricsnormal values and potential use in the assessment of cardiac injury
J Pediatr
(1997) - et al.
Vulnerability of pediatric myocardium to cardiac surgery
Heart
(1996)