Abstract
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.
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Acknowledgements
The authors would like to express their gratitude to Brent Shafer, PA and our team of pediatric echocardiographic sonographers; Celeste Kessler RDCS, Kyle G. West RDCS, Angie Galan RDCS and Megan Ragan RDCS for their assistance with this interesting case.
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All procedures performed were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. This article does not contain any studies with animals performed by any of the authors. Need for parental consent was waived.
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VanLoozen, D.H., Murdison, K.A. & Polimenakos, A.C. 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. Pediatr Cardiol 39, 1496–1499 (2018). https://doi.org/10.1007/s00246-018-1940-6
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DOI: https://doi.org/10.1007/s00246-018-1940-6