Neonatal Myocardial Perfusion in Right Ventricle Dependent Coronary Circulation: Clinical Surrogates and Role of Troponin-I in Postoperative Management Following Systemic-to-Pulmonary Shunt Physiology

• Published in: Pediatric cardiology Vol. 39; no. 7; pp. 1496 - 1499
• Main Authors: VanLoozen, Dennis H., Murdison, Kenneth A., Polimenakos, Anastasios C.
• Format: Journal Article
• Language: English
• Published: New York Springer US 01.10.2018; Springer
• Subjects: Biomarkers - blood; Cardiac patients; Cardiac Surgery; Cardiology; Case Report; Coronary Artery Disease - blood; Coronary Artery Disease - complications; Coronary Circulation - physiology; Forecasts and trends; Heart Bypass, Right - adverse effects; Heart Bypass, Right - methods; Heart Defects, Congenital - complications; Heart Defects, Congenital - surgery; Heart Ventricles - abnormalities; Humans; Infant, Newborn; Infants (Newborn); Ischemia; Male; Medicine; Medicine & Public Health; Myocardial Ischemia - blood; Myocardial Ischemia - etiology; Physiological aspects; Postoperative Care - methods; Postoperative Period; Pulmonary Atresia - complications; Pulmonary Atresia - surgery; Strategic planning (Business); Treatment Outcome; Troponin I - blood; Vascular Surgery; Post-operative; Right ventricle dependent coronary circulation; Pulmonary atresia; Congenital; Troponin-I
• ISSN: 0172-0643; 1432-1971
• DOI: 10.1007/s00246-018-1940-6

Right ventricle dependent coronary circulation (RVDCC) in pulmonary atresia with intact ventricular septum (PA/IVS) is associated with significant mortality risk in the immediate post-operative period following the initial stage of surgical palliation. Prognosis remains guarded during the interstage period towards conversion to the superior cavopulmonary shunt physiology. Current literature is scarce regarding this specific patient population. Cardiac troponin-I is widely used as a marker of coronary ischemia in adults, but its use for routine monitoring of neonatal myocardial tissue injury due to supply/demand perfusion mismatch is, yet to be determined. We sought to evaluate the clinical correlation of cTnl perioperative use in a PA/IVS RVDCC case and assess its interplay with established clinical, echocardiographic, and laboratory variables in guiding a real-time (dynamic) management strategy following systemic-to-pulmonary shunt palliation.