The Journal of thoracic and cardiovascular surgery
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J. Thorac. Cardiovasc. Surg. · May 1987
Constant postoperative monitoring of cardiac output after correction of congenital heart defects.
A new method has been developed that permits constant postoperative monitoring of mean and phasic cardiac output in patients after correction of congenital heart defects. A miniature ultrasound probe is attached to the adventitia of the ascending aorta at the conclusion of the operative procedure. This is connected to the monitoring equipment by means of polyurethane-covered wires that exit the chest wall through a small stab wound. ⋯ Regression analysis revealed a high linear correlation (r = 0.9) between the two techniques. A monitor can display the cardiac output trend with 1 minute updates, which greatly enhance management of intravenous drug therapy and volume administration. In conclusion, this new extraluminal removable probe allows virtually continuous monitoring of the postoperative cardiac output after correction of congenital heart defects and should become a standard technique in the postoperative care of these patients.
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J. Thorac. Cardiovasc. Surg. · May 1987
Central aorta-pulmonary artery shunts in neonates with complex cyanotic congenital heart disease.
Methods of palliating critical pulmonary oligemia in neonates with complex cyanotic congenital heart disease continue to evolve. Pulmonary artery distortion and other complications of the use of native vessels to increase pulmonary blood flow has led to the more frequent use of polytetrafluoroethylene shunts either in a central position or as a modified Blalock-Taussig shunt. Central aorta-pulmonary artery shunts have largely fallen into disfavor because of previously reported unacceptably high incidences of complications such as shunt thrombosis, congestive heart failure, and pulmonary artery distortion. ⋯ Repeat catheterization was performed in 12 patients; pulmonary angiography showed good growth of both pulmonary arteries and there was no evidence of pulmonary artery hypertension. Although minor pulmonary artery distortion was present in two patients, this distortion was centrally located and easily remedied at the time of total correction. Thus we have found the central aorta-pulmonary artery shunt to be an extremely effective and reliable means of palliating pulmonary artery hypoplasia as a result of pulmonary atresia or severe pulmonary stenosis in neonates.
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J. Thorac. Cardiovasc. Surg. · May 1987
Nitroprusside abolishes the deleterious effects of surface cooling-induced hypothermia on immature pigs with ventricular septal defects.
The efficacy of systemic hypothermia in combination with cardiopulmonary bypass for the repair of congenital cardiac malformations is established. Surface cooling in infants with ventricular septal defects as a prebypass adjunct has been associated with visceral ischemic complications. Surface cooling in infant pigs with ventricular septal defects results in increased systemic vascular resistance and unchanged pulmonary vascular resistance with increased left-to-right shunting and a maldistribution of blood flow away from the viscera and kidneys. ⋯ Additionally, the vasodilatory effect allowed the animals to cool twice as fast as animals without nitroprusside. Regional blood flow distribution as percent cardiac output and absolute tissue flow were protected during surface cooling. This technique may have a role in cardiac operations on infants with left-to-right shunts.