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In 72 infants with SVHD undergoing stage 2 palliation (S2P) and 41 controls, we quantified serum KP metabolite concentrations via tandem mass spectroscopy pre\u2010S2P and post\u2010S2P at 2, 24, and 48\u2009h and assessed metabolite relationships with post\u2010S2P outcomes (length of stay, hypoxemia burden, and intubation duration). Pre\u2010S2P, SVHD infants had lower tryptophan and serotonin levels and higher kynurenic acid, 3\u2010hydroxykynurenine, and picolinic acid levels than controls. Post\u2010S2P, metabolites peaked at 2\u2009h, with return to baseline by 48\u2009h for all except kynurenic acid, which remained elevated. Metabolite concentrations pre\u2010S2P were poorly associated with outcomes. A lower serotonin peak 2\u2009h post\u2010S2P was associated with longer length of stay and intubation duration. Multiple metabolites at 24 and 48\u2009h correlated with outcomes; notably, elevated kynurenic acid was associated with worse results for all three outcomes. Our results confirm that interstage SVHD infants have altered KP activity compared to controls. Further, the link between outcomes and KP metabolites post\u2010S2P\u2014but not at baseline\u2014demonstrates that acute, perioperative changes in tryptophan catabolism may be more important to tolerating S2P physiology than chronic interstage changes.<\/jats:p>","DOI":"10.14814\/phy2.70133","type":"journal-article","created":{"date-parts":[[2024,11,25]],"date-time":"2024-11-25T02:46:32Z","timestamp":1732502792000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Perturbations of tryptophan catabolism via the kynurenine pathway are associated with stage 2 postoperative outcomes in single ventricle heart disease"],"prefix":"10.14814","volume":"12","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-8597-2690","authenticated-orcid":false,"given":"Jennifer","family":"Romanowicz","sequence":"first","affiliation":[{"name":"Department of Pediatrics, Section of Cardiology Children's Hospital Colorado and University of Colorado Anschutz  Aurora Colorado USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sierra","family":"Niemiec","sequence":"additional","affiliation":[{"name":"Department of Biostatistics and Informatics University of Colorado Anschutz  Aurora Colorado USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ludmila","family":"Khailova","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, Section of Cardiology Children's Hospital Colorado and University of Colorado Anschutz  Aurora Colorado USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Tanner","family":"Lehmann","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, Section of Cardiology Children's Hospital Colorado and University of Colorado Anschutz  Aurora Colorado USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Christopher A.","family":"Mancuso","sequence":"additional","affiliation":[{"name":"Department of Biostatistics and Informatics University of Colorado Anschutz  Aurora Colorado USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Max B.","family":"Mitchell","sequence":"additional","affiliation":[{"name":"Department of Cardiac Surgery Children's Hospital Colorado and University of Colorado Anschutz  Aurora Colorado USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Gareth J.","family":"Morgan","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, Section of Cardiology Children's Hospital Colorado and University of Colorado Anschutz  Aurora Colorado USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mark","family":"Twite","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology University of Colorado Anschutz  Aurora Colorado USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Michael V.","family":"DiMaria","sequence":"additional","affiliation":[{"name":"Congenital Heart Center University of Michigan C.S. 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