Seminars in thoracic and cardiovascular surgery. Pediatric cardiac surgery annual
-
Semin Thorac Cardiovasc Surg Pediatr Card Surg Annu · Jan 2005
ReviewNoninvasive assessment of cardiac output.
Improved outcome from shock depends on early detection and correction of circulatory abnormalities. Global cardiac output and oxygen delivery must be adequate and distributed appropriately to meet metabolic demands to prevent the development of multiple organ system dysfunction, prolonged morbidity, and death. Circulatory assessment using standard monitors gives incomplete and sometimes misleading information. This article focuses on the available and emerging technologies that emphasize assessment of blood flow and regional tissue oxygenation.
-
Semin Thorac Cardiovasc Surg Pediatr Card Surg Annu · Jan 2005
ReviewAdvances in perioperative pacing.
Cardiac resynchronization therapy with biventricular pacing has become a significant management tool in adults with heart failure. In children, right rather than just left ventricular failure, is a key problem in the postoperative period. ⋯ There are now preliminary reports in the literature of the use of multiple temporary pacing sites after congenital heart surgery and acute comparison of the effects of unsynchronized versus synchronized pacing in the postoperative period. These studies support the use of cardiac resynchronization pacing at least as a temporary measure in cases of acute heart failure after surgery in patients with congenital heart disease.
-
Semin Thorac Cardiovasc Surg Pediatr Card Surg Annu · Jan 2005
ReviewReducing risk in infant cardiopulmonary bypass: the use of a miniaturized circuit and a crystalloid prime improves cardiopulmonary function and increases cerebral blood flow.
Advances in perfusion strategies have played an important role in improving outcomes following repair of complex congenital heart defects. The influence of cooling strategy, temperature, duration of circulatory arrest, and specific method of cerebral perfusion on neurologic morbidity have been extensively characterized. ⋯ We recently showed that employment of a miniaturized circuit and a bloodless prime reduce inflammation and have salutary effects on cardiopulmonary function following hypothermic low-flow perfusion (HLF), and that this circuit may also improve cerebral protection following both deep hypothermic circulatory arrest and HLF. The current report, therefore, reviews current strategies utilized to minimize post-CPB inflammation and highlights the empirical evidence from our laboratory demonstrating the beneficial role of a miniaturized extracorporeal circuit in this context.
-
Semin Thorac Cardiovasc Surg Pediatr Card Surg Annu · Jan 2004
Right ventricle-pulmonary artery shunt in first-stage palliation of hypoplastic left heart syndrome.
This article reviews our experience using a prosthetic conduit between the right ventricle (RV) and the pulmonary artery (PA), in lieu of the more traditional aortopulmonary shunt, for infants undergoing surgical palliation of hypoplastic left heart syndrome. Thirty-three consecutive infants underwent Norwood procedure between February 1998 and November 2003, using an RV-PA conduit. ⋯ Nine patients have undergone completion Fontan. This technique provides reproducible results, simplifies postoperative management, and improves outcome, especially for "low volume" programs.
-
Semin Thorac Cardiovasc Surg Pediatr Card Surg Annu · Jan 2004
ReviewHeart transplantation for the failing Fontan circulation.
The failing Fontan circulation presents difficult treatment challenges. When Fontan revision and or intervention for treatable arrhythmias are not feasible, heart transplantation is the only therapeutic option. ⋯ The pretransplant evaluation, transplant operation, and postoperative management are more problematic for these patients compared with most patients undergoing transplantation. Consequently, failing Fontan patients constitute one of the highest risk heart transplant subsets.