PATTERNS AND POTENTIAL VALUE OF CARDIAC TROPONIN-I ELEVATIONS AFTER PEDIATRIC CARDIAC OPERATIONS

Background. Perioperative myocardial injury is a major determinant of postoperative cardiac dysfunction for congenital heart disease, but it s assessment during this period is difficult. The objective of this st udy was to determine the suitability of using postoperative serum conc entrations of cardiac troponin I (cTnI) for this purpose. Methods. Car diac troponin I levels were measured serially in the serum of patients undergoing uncomplicated repairs of atrial septal defect (n = 23), ve ntricular septal defect (n = 16) or tetralogy of Fallot (n = 16). The concentrations were correlated with intraoperative parameters (cardiop ulmonary bypass time, aortic cross; clamp time, and cardiac bypass tem perature), and postoperative parameters (magnitude of inotropic suppor t, duration of intubation, and postoperative intensive care and hospit al, stay). Results. Postoperative absolute cTnI levels were lesion spe cific, with a pattern of increase and decrease similar for each lesion . For the total cohort, significant correlations between postoperative cTnI levels at all times (r = 0.43 to 0.83, p < 0.05) until 72 hours were noted for all parameters, except for cardiac bypass temperature. When evaluated as individual procedure groups, no significant ,ur-rela tionships were noted in the atrial septal defect group, whereas postop erative cTnI levels were more strongly red correlated with all intraop erative and postoperative parameters in the ventricular septal defect group than in the tetralogy of Fallot group. Conclusions. This study s uggests that cTnI values immediately after operation reflect the exten t of myocardial damage from both incisional injury and intraoperative factors. Cardiac tropinin I levels in the first hours after operation for congenital heart disease are a potentially useful prognostic indic ator for difficulty of recovery. (C) 1998 by The Society of Thoracic S urgeons.