Early pleural effusions related to the myocardial injury after open-heart surgery for congenital heart disease

Monesha Gupta-Malhotra, Jeffrey H. Kern, Patrick A. Flynn, Myles S. Schiller, Jan M. Quaegebeur, Deborah M. Friedman

Research output: Contribution to journalArticle

2 Citations (Scopus)

Abstract

Objectives.: The degree of effusion immediately after cardiopulmonary bypass (CPB) can vary and may reflect several factors including the degree of myocardial injury. We compared the degree of pleural effusions after CPB to the overall myocardial injury as determined by serum cardiac troponin I (cTnI) levels after elective repair of a variety of congenital heart defects, including univentricular surgeries via cavopulmonary shunts. Methods.: Serum was collected pre-CPB, post-CPB, and daily after that and cTnI level measured. The postoperative pleural effusion was measured each day until the chest tube was removed. Results.: The 21 study patients were of average age of 5.5 years (±5.6). The duration of chest-tube drainage after open-heart surgery was 4.3 days (±3.5) and the amount was 2.4 mL/kg/hour (±2.9). For the biventricular repairs, cTnI levels on the postoperative day (POD) 1 best correlated with amount of effusion (n = 16, r = 0.5, P = 0.02) and the average (POD 0-3) cTnI levels with the total duration (n = 16, r = 0.4, P = 0.01) and also the amount (n = 16, r = 0.5, P = 0.02) of effusions. For the cavopulmonary shunts, the post-CBP cTnI level best correlated with the duration (n = 5, r = 0.8, P = 0.02) and amount (n = 5, r = 0.9, P = 0.02) of effusions. A cTnI level on the first postoperative day ≥15 μg/L was associated with effusions >2 days (sensitivity of 81% and specificity of 80%). Conclusion.: We found that higher the cTnI released, especially ≥15 μg/L, longer the duration and greater the amount of early pleural effusions for a variety of congenital heart surgeries including cavopulmonary shunts. A number of factors may lead to excessive pleural effusions and the degree of myocardial injury may be one of them.

Original languageEnglish (US)
Pages (from-to)256-261
Number of pages6
JournalCongenital Heart Disease
Volume5
Issue number3
DOIs
StatePublished - 2010

Fingerprint

Troponin I
Pleural Effusion
Thoracic Surgery
Heart Diseases
Right Heart Bypass
Cardiopulmonary Bypass
Wounds and Injuries
Chest Tubes
Congenital Heart Defects
Serum
Drainage
Sensitivity and Specificity

Keywords

  • Cardiac troponin I
  • Cardiopulmonary bypass
  • Cavopulmonary shunts
  • Congenital cardiac malformation
  • Fontan surgery
  • Glenn surgery

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Pediatrics, Perinatology, and Child Health
  • Surgery
  • Radiology Nuclear Medicine and imaging
  • Medicine(all)

Cite this

Early pleural effusions related to the myocardial injury after open-heart surgery for congenital heart disease. / Gupta-Malhotra, Monesha; Kern, Jeffrey H.; Flynn, Patrick A.; Schiller, Myles S.; Quaegebeur, Jan M.; Friedman, Deborah M.

In: Congenital Heart Disease, Vol. 5, No. 3, 2010, p. 256-261.

Research output: Contribution to journalArticle

Gupta-Malhotra, Monesha ; Kern, Jeffrey H. ; Flynn, Patrick A. ; Schiller, Myles S. ; Quaegebeur, Jan M. ; Friedman, Deborah M. / Early pleural effusions related to the myocardial injury after open-heart surgery for congenital heart disease. In: Congenital Heart Disease. 2010 ; Vol. 5, No. 3. pp. 256-261.
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AU - Quaegebeur, Jan M.

AU - Friedman, Deborah M.

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N2 - Objectives.: The degree of effusion immediately after cardiopulmonary bypass (CPB) can vary and may reflect several factors including the degree of myocardial injury. We compared the degree of pleural effusions after CPB to the overall myocardial injury as determined by serum cardiac troponin I (cTnI) levels after elective repair of a variety of congenital heart defects, including univentricular surgeries via cavopulmonary shunts. Methods.: Serum was collected pre-CPB, post-CPB, and daily after that and cTnI level measured. The postoperative pleural effusion was measured each day until the chest tube was removed. Results.: The 21 study patients were of average age of 5.5 years (±5.6). The duration of chest-tube drainage after open-heart surgery was 4.3 days (±3.5) and the amount was 2.4 mL/kg/hour (±2.9). For the biventricular repairs, cTnI levels on the postoperative day (POD) 1 best correlated with amount of effusion (n = 16, r = 0.5, P = 0.02) and the average (POD 0-3) cTnI levels with the total duration (n = 16, r = 0.4, P = 0.01) and also the amount (n = 16, r = 0.5, P = 0.02) of effusions. For the cavopulmonary shunts, the post-CBP cTnI level best correlated with the duration (n = 5, r = 0.8, P = 0.02) and amount (n = 5, r = 0.9, P = 0.02) of effusions. A cTnI level on the first postoperative day ≥15 μg/L was associated with effusions >2 days (sensitivity of 81% and specificity of 80%). Conclusion.: We found that higher the cTnI released, especially ≥15 μg/L, longer the duration and greater the amount of early pleural effusions for a variety of congenital heart surgeries including cavopulmonary shunts. A number of factors may lead to excessive pleural effusions and the degree of myocardial injury may be one of them.

AB - Objectives.: The degree of effusion immediately after cardiopulmonary bypass (CPB) can vary and may reflect several factors including the degree of myocardial injury. We compared the degree of pleural effusions after CPB to the overall myocardial injury as determined by serum cardiac troponin I (cTnI) levels after elective repair of a variety of congenital heart defects, including univentricular surgeries via cavopulmonary shunts. Methods.: Serum was collected pre-CPB, post-CPB, and daily after that and cTnI level measured. The postoperative pleural effusion was measured each day until the chest tube was removed. Results.: The 21 study patients were of average age of 5.5 years (±5.6). The duration of chest-tube drainage after open-heart surgery was 4.3 days (±3.5) and the amount was 2.4 mL/kg/hour (±2.9). For the biventricular repairs, cTnI levels on the postoperative day (POD) 1 best correlated with amount of effusion (n = 16, r = 0.5, P = 0.02) and the average (POD 0-3) cTnI levels with the total duration (n = 16, r = 0.4, P = 0.01) and also the amount (n = 16, r = 0.5, P = 0.02) of effusions. For the cavopulmonary shunts, the post-CBP cTnI level best correlated with the duration (n = 5, r = 0.8, P = 0.02) and amount (n = 5, r = 0.9, P = 0.02) of effusions. A cTnI level on the first postoperative day ≥15 μg/L was associated with effusions >2 days (sensitivity of 81% and specificity of 80%). Conclusion.: We found that higher the cTnI released, especially ≥15 μg/L, longer the duration and greater the amount of early pleural effusions for a variety of congenital heart surgeries including cavopulmonary shunts. A number of factors may lead to excessive pleural effusions and the degree of myocardial injury may be one of them.

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KW - Glenn surgery

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