Seminars in thoracic and cardiovascular surgery. Pediatric cardiac surgery annual
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Semin Thorac Cardiovasc Surg Pediatr Card Surg Annu · Jan 2011
ReviewObjective assessment of cardiac output in infants after cardiac surgery.
An accurate measurement of cardiac performance in infants after cardiopulmonary bypass has long been considered to be an important part of postoperative management. To be useful in clinical decision making, such measurements should ideally be reproducible, non invasive and accurately reflect tissue perfusion and oxygen delivery. ⋯ These all have the same shortcoming, that they provide a number that the information as to whether it provides adequate tissue perfusion. There is increasing emphasis being placed on the measurement of oxygen delivery either by mixed venous oxygen saturation and serum lactate, which are important markers of the adequacy of organ perfusion; and relating this to outcome, the development of organ dysfunction and length of ICU stay.
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Semin Thorac Cardiovasc Surg Pediatr Card Surg Annu · Jan 2011
Review Comparative StudyExtracardiac versus intra-atrial lateral tunnel fontan: extracardiac is better.
This article was prepared to summarize the points made in a debate that the first author (C. L. B.) had with Dr. ⋯ This review summarizes our results at Children's Memorial Hospital (Chicago, IL) with 180 patients undergoing a primary Fontan procedure and 126 patients undergoing an extracardiac Fontan as part of a Fontan conversion. The world literature was reviewed on outcomes following the Fontan procedure, focusing on six main areas supporting the superiority of the extracardiac Fontan: hemodynamics, arrhythmias, applicability to complex anatomy, use of cardiopulmonary bypass, complications of fenestration and thromboembolism, and operative mortality. Based on this review, it is our conclusion that the extracardiac Fontan is the procedure of choice for patients with a functional single ventricle based on a very low operative mortality, a lower incidence of early and late arrhythmias, improved hemodynamics, fewer postoperative complications, and applicability to a wide variety of complex cardiac anatomy.
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Semin Thorac Cardiovasc Surg Pediatr Card Surg Annu · Jan 2011
ReviewSupravalvar aortic stenosis in infancy.
Supravalvar aortic stenosis (SVAS) is a rare anomaly of the aortic root caused by a genetically based deficiency in elastin production. Concomitant primary and secondary cardiovascular lesions complicate surgical management and impact early and late outcomes. ⋯ Patients who come to surgery during infancy are particularly challenging, but little attention has been directed as to whether or not young age influences outcomes. This review suggests that complicating associated features of elastin arteriopathy are more prevalent in patients who require relief of SVAS during infancy, and that concomitant lesions significantly increase the difficulty and risk of treating younger patients with SVAS.
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Semin Thorac Cardiovasc Surg Pediatr Card Surg Annu · Jan 2011
ReviewAortic complications after pediatric cardiac transplantation in patients with a previous Norwood reconstruction.
Despite increasing surgical success with staged palliation of hypoplastic left heart syndrome and its variants, some of these children eventually may require cardiac transplantation. Sixteen (7.8%) of 206 children ≤18 years old undergoing primary heart transplantation had a previous Norwood palliation. Two (12.5%) developed significant aortic problems after transplantation related to the initial homograft reconstruction of the aorta. ⋯ Patient 2 had multiple balloon dilatations of recurrent coarctation after transplantation. Eighteen years post-transplant, during work-up for chronic fever and weight loss, computerized tomography showed a mycotic aneurysm of the reconstructed transverse aorta with contained rupture necessitating removal and replacement of the entire reconstructed aorta. Although uncommon, aortic complications in pediatric heart transplant patients with previous Norwood arch reconstruction can present with unusual manifestations requiring heightened vigilance.