Myocardial damage in children may be clinically occult in a variety of stressful settings. However, biochemical markers have not been routinely used in children at risk for myocardial damage due to a lack of sufficient specificity to unambiguously guide patient management. Cardiac specific troponins T and I have become established as the gold standard biochemical markers for myocardial necrosis. Abnormalities of cardiac function are frequent in patients with sepsis. In one report, approximately 50% of patients with severe sepsis and septic shock may develop impairment of ventricular performance. Whereas evaluation of myocardial performance during septic shock is of critical importance to select the best therapeutic options. Lactate is a marker in shock & occult hypoperfusion , lactate has been addressed after cardiac surgery in pediatric patients in many studies.