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Vulnerability of paediatric myocardium to cardiac surgery
D P Taggart1, L Hadjinikolas, K Wong
1Department of Cardiothoracic Surgery, Royal Brompton Hospital, London.
Insights
Paediatric cardiac surgery can cause myocardial injury. Cardiac troponins are the best markers, showing the paediatric heart is more vulnerable than the adult heart during surgery.
Area of Science:
- Cardiology
- Pediatric Surgery
- Biochemistry
Background:
- Myocardial injury is a significant risk factor for mortality and morbidity following pediatric cardiac surgery.
- While animal studies suggest juvenile myocardium is more resistant to ischemia-reperfusion injury than adult myocardium, clinical evidence is limited.
Purpose of the Study:
- To investigate biochemical markers of myocardial injury in children undergoing cardiac surgery.
- To compare the vulnerability of pediatric myocardium to surgical injury versus adult myocardium.
Main Methods:
- Prospective observational study involving 40 pediatric patients undergoing various cardiac surgeries.
- Serial measurements of myoglobin, creatine kinase-MB (CK-MB), cardiac troponin T (cTnT), and cardiac troponin I (cTnI) were performed pre- and post-operatively.
- A control group underwent less complex procedures like patent ductus arteriosus closure.
Main Results:
- Significant increases in myoglobin and CK-MB were observed in the control group, but not cTnT or cTnI.
- All four biochemical markers significantly increased in pediatric cardiac surgery patients, particularly those with ventricular septal defects and transposition.
- Increases in CK-MB and cTnT were approximately five times higher than reported in adult patients.
Conclusions:
- Cardiac troponins (cTnT and cTnI) are more specific indicators of myocardial injury in pediatric cardiac surgery compared to myoglobin and CK-MB.
- Pediatric myocardium appears to be more susceptible to injury during cardiac surgery than adult myocardium.
Objective:
Myocardial injury is an important cause of mortality and morbidity after paediatric cardiac surgery. Data obtained from studies in animals imply that juvenile myocardium is more resistant to the effects of ischaemia and reperfusion than adult myocardium but there is little confirmatory evidence in the clinical setting.
Design:
Prospective observational study of biochemical markers of myocardial injury in a paediatric population undergoing cardiac surgery.
Setting:
Tertiary referral centre for paediatric cardiac surgery.
Patients:
Forty patients undergoing paediatric cardiac surgery of varying complexity including closure of atrial and ventricular septal defects and arterial switch for simple transposition. A control group included patients undergoing thoracotomy for closure of a patent ductus arteriosus or repair of a coarctation.
Interventions:
Serial measurements of myoglobin, the MB isoenzyme of creatine kinase (CK-MB), and the highly specific markers of myocardial damage cardiac troponin T (cTnT) and I (cTnI) were made before and 1, 6, 24, and 48 to 72 hours after operation.
Results:
There were significant increases in myoglobin and CK-MB, but not cTnT or cTnI, in the control group. There were significant increases in the four biochemical markers in all the cardiac operations but especially in the ventricular septal defect and transposition group. Increases in CK-MB and cTnT were about five times greater than those previously reported in adult patients.
Conclusions:
(i) Cardiac troponins are more specific markers of myocardial injury in paediatric cardiac surgery than myoglobin and CK-MB. (ii) Paediatric myocardium seems to be more vulnerable to injury during cardiac surgery than adult myocardium.