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      The behavior of Troponin I and CKMB mass in children who underwent surgical correction of congenital heart malformations Translated title: Comportamento da troponina I e CK-MB massa em crianças submetidas a correção cirúrgica das cardiopatias congênitas

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          Abstract

          OBJECTIVE: To analyze the behavior of troponin (TROP I) and CKMB mass (CKMBm) in regards to the addition of magnesium in cardioplegic solutions; and also the influence of per-operative factors. METHOD: A total of 28 children with ages ranging from 3 to 108 months were studied. The mean weight was 11.8 kg. Eighteen were male. The patients were divided into two groups. Sixteen children in group I (GI) and 12 in group II (GII). The patients in GI received cold blood cardioplegic solution with magnesium (12 mEq/L) and potassium chloride (20 mEq/L) at 20 mL/kg. The patients in GII received the same solution without magnesium. Six blood samples were collected for serum analysis of the concentration of TROP I and CKMBm. The blood samples were collected before clamping the aorta and at 1, 6, 24, 48 and 72 hours after aorta clamping termination. RESULTS: There were no statistical differences in the TROP I and CKMBm levels between the two groups. Among the per-operative factors cyanosis influenced the TROP I and CKMBm levels. Additionally, the aorta clamping time influenced the TROP I levels. CONCLUSIONS: The addition of magnesium in the cardioplegic solution was not associated with different levels of TROP I and CKMBm. Cyanosis and aorta clamping time interfered with peak TROP I levels.

          Translated abstract

          OBJETIVO: Analisar o comportamento da troponina I (TROP I) e CKMB massa (CKMBm) conforme a adição ou não de magnésio (Mg) na cardioplegia e a influência dos fatores operatórios. MÉTODO: Foram estudadas 28 crianças com a idade de 3 a 108 meses, peso médio de 11,8 kg, sendo 18 do sexo masculino, divididas em dois grupos, 16 no grupo I (GI) e 12 no grupo II (GII). O GI recebeu solução cardioplégica sangüínea fria com Mg 12 mEq/L e cloreto de potássio 20 mEq/L na dose de 20 mL/kg. O GII recebeu a mesma solução sem o (Mg). Foram coletadas seis amostras de sangue para a dosagem sérica de TROP I e CKMBm: pré-pinçamento da aorta e com 1, 6, 24, 48 e 72 horas após o término do pinçamento da aorta. RESULTADOS: Os resultados demonstraram que não houve diferença estatisticamente significante nos níveis TROP I e CKMBm, entre GI e GII. Dentre os fatores operatórios, a cianose influenciou nos níveis de TROP I e CKMBm, enquanto que o tempo de pinçamento da aorta (TPA) influenciou nos níveis de TROP I. CONCLUSÕES: A adição de Mg na solução cardioplégica não esteve associada com níveis diferentes de TROP I e CKMBm. A cianose e o TPA interferiram no pico de TROP I.

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          Most cited references25

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          Cardiac troponin I and troponin T: are enzymes still relevant as cardiac markers?

          J. Mair (1997)
          Creatine kinase (CK) MB and lactate dehydrogenase (LDH) isoenzyme 1 are not heart-specific. By contrast, the regulatory proteins troponin I and troponin T are expressed in three different isoforms, one for slow-twitch skeletal muscle fibers, one for fast-twitch skeletal muscle fibers, and one for cardiac muscle (cTnI, cTnT). cTnI and cTnT are usually not detectable in patients without myocardial damage, which is a prerequisite for high diagnostic performance. After acute myocardial infarction (AMI) cTnI, cTnT, and CKMB mass have a comparable early sensitivity. cTnI and cTnT usually peak in parallel except for patients without reperfusion in whom cTnI peaks about 1 day and cTnT approximately 3-4 days after onset of AMI. Both stay increased for at least 4-5 days. cTnT tends to stay increased longer than cTnI. Because the sensitivities of cTnI and cTnT for myocardial injury are comparable, their specificities are the main topic of current debate. Recent reports on mismatches of cTnI and cTnT in patients with renal failure and myopathy without other evidence for myocardial injury suggest that cTnT could be reexpressed similar to CKMB and LDH-1 in chronically damaged human skeletal muscle. In contrast to cTnT, CKMB, and LDH-1, cTnI is not expressed in skeletal muscle during fetal development. So far, an increase in cTnI has been reported only after myocardial damage. Because of currently higher costs, troponin measurement should be restricted at present to clinical settings that really require their high specificity. Based on its distinct functional association with the metabolism of acute ischemic myocardium and according to initial clinical results, glycogen phosphorylase isoenzyme BB is a promising enzyme for the early detection of ischemic myocardial damage.
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            The intrinsic physiologic properties of the developing heart.

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              A comparison of pressure-volume relations of the fetal, newborn, and adult heart.

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                Author and article information

                Contributors
                Role: ND
                Role: ND
                Role: ND
                Role: ND
                Role: ND
                Role: ND
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                Role: ND
                Journal
                rbccv
                Brazilian Journal of Cardiovascular Surgery
                Braz. J. Cardiovasc. Surg.
                Sociedade Brasileira de Cirurgia Cardiovascular (São José do Rio Preto )
                1678-9741
                September 2003
                : 18
                : 3
                : 235-241
                Article
                S0102-76382003000300008
                10.1590/S0102-76382003000300008
                6ff88a8a-8acb-4cb2-bcd3-581b02ce8612

                http://creativecommons.org/licenses/by/4.0/

                History
                Product

                SciELO Brazil

                Self URI (journal page): http://www.scielo.br/scielo.php?script=sci_serial&pid=0102-7638&lng=en
                Categories
                CARDIAC & CARDIOVASCULAR SYSTEMS
                SURGERY

                Surgery,Cardiovascular Medicine
                Troponin I,Creatine kinase,Magnesium sulfate,Cardioplegic solutions,Heart defects, congenital,Troponina I,Creatina quinase,Cardiopatias congênitas,Sulfato de magnésio,Soluções cardioplégicas

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