Cardiac Troponin I Level before and after Elective Open Heart Surgery in Pediatrics

Cardiac troponin I was found to be a sensitive and high specific marker of myocardial injury even in the pediatric population. This study aimed to elucidate the value of serum cardiac troponin I level after cardio-pulmonary bypass and effect of the time of aortic clamp duration on troponin I level. In this descriptive cross-sectional study, serum troponin I level measured before, 0.5 and 24 hours after open heart surgery in one hundred pediatric patients (58 female and 42 male) with mean age of 4.5 years old (15 month to 19 years) undergoing elective open heart surgery for congenital heart disease in Tehran Shahid Rajaei cardiovascular hospital. Patients’ demographic data, surgical procedure, length of intensive care unit stay, inotropic support requirement and their duration of endotracheal intubations and aortic cross clamping time on the troponin level were recorded. Baseline serum troponin level's were less than 0.1 mg/mm, stay of intensive care unit was significantly higher in patients with high troponin I level at 0.5 and 24 hour after surgery (P = 0.005, r = 0.275 and P = 0.001, r = 0.543, respectively). Troponin I level 0.5 and 24 hour after surgery was strongly related to intubation time (P = 0.004, r = 0.258 and P = 0.001, r = 0.473, respectively). Only Troponin I level's in 24 hour after surgery remained significantly predicative of need to Inotropic Agents (P = 0.001, r = 0.637). There was strongly relation between time of cardio pulmonary by-pass and troponin levels 0.5 and 24 hour after surgery (P = 0.001, r = 0.320 and P = 0.019, r = 0.235, respectively). However, aortic cross clamping time affect to troponin I level only 0.5 hour after surgery (P = 0.001, r = 0.402). Evaluation of the cardiac troponin I level in patient undergone open heart surgery represent acute myocardial damage, allows further stratification of risk when combined with standard measures. Post operative troponin I level predicts length of intensive care unit stay, need for inotropic agents, and length of need for inotropic agents and intubation time.