الفهرس 
Troponin_1 as a predictor of outcome in pediatric postoperative cardiac surgeriesV
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Abstract
With technological improvement in anesthesia of cardiac surgery, cardiopulmonary bypass (CPB), and continuation of extracorporeal circulation, there has been significant development in pediatric and adult cardiac surgery. It is well known that myocardial injury secondary to surgery or CPB affects cardiac functions, therefore increase morbidity and mortality. Pediatric open heart surgery is a special operation that has different success rates depending on the quality of technique. Intraoperative myocardial tissue injury affects a postoperative cardiac function which is directly related with morbidity and mortality (Moon et al., 2014).
Several studies have shown that cardiac troponin I levels are safe can be used as an indicator of myocardial damage both in pediatric and adult cardiac surgery. Increased troponin I levels have been associated with postoperative complications like delayed extubation time, necessity of higher inotropic support, and mortality (Wang et al., 2020).
Cardiac troponin I (cTnI) is a regulatory protein with a high sensitivity and specificity for cardiac injury. The cTnI has no cross-reactivity with the skeletal muscle forms and is produced only in the myocardium throughout development. Any type of cardiac injury, including a myocardial infarction, pericarditis (Blich et al., 2008),advanced heart failure, inflammatory process, toxic agents, or trauma can result in the release of the cTnI into the blood. Also, preoperative and postoperative elevations of the cTnI are usually considered predictors of the mortality and morbidity not only in adults but also in infants and children (Jennifer et al., 2019).
Moreover, a significant volume and pressure overload due to a left-to-right shunt induce myocardial injury and a cTnI elevation (Momeni et al., 2017).Cardiac surgery for congenital heart disease (CHD) is associated with the postoperative morbidity and mortality, especially in neonates and infants. Severe cardiac damage and necrosis after cardiac surgery may result in a longer ICU stay and may cause death. However, little is known about the relationship between the cTnI and duration of the catecholamine use, ICU stay, and other clinical parameters including the urine volume and lactate level (Kojima et al., 2020).
Several authors have suggested prognostic implications of troponin concentrations measured early in children undergoing cardiac surgery (Froese et al., 2009).However, troponin release after surgery for congenital cardiac disease is multifactorial and depends on the type of procedure being performed. Overall, pediatric literature on this topic has included small samples and various case mixes, rendering conclusions difficult to draw(Bojan et al., 2012).
In the present study, we will aim to assess whether the cTnI is an independent prognostic marker after a CHD operation. In this study, we will aim to evaluate the effects of troponin I on postoperative mortality and morbidity in patients between one day and 15 years old who underwent congenital cardiac surgery.