Postoperative Course and Hemodynamic Profile After the Arterial Switch Operation in Neonates and Infants

Abstract

After heart surgery in neonates and infants, both low-flow bypass and circulatory arrest perfusion strategies have comparable effects on the nonneurological postoperative course and hemodynamic profile.

Efficacy and Safety of Milrinone in Preventing Low Cardiac Output Syndrome in Infants and Children After Corrective Surgery for Congenital Heart Disease

“…Because these values were not measured consistently at all sites and with a decreasing frequency during the study infusion, only limited conclusions can be drawn from these data. Consistent with previous studies, [2][3][4][5]15 the lowest mixed venous oxygen saturations and highest lactate values occurred in the first 12 hours after surgery. Although no statistically significant differences were identified between treatment groups, there was a trend toward a wider difference between arterial and mixed venous oxygen saturations at 8 and 12 hours after surgery in the placebo arm compared with those treated with high-dose milrinone (Figure 5, PϽ0.07).…”

“…Baseline catecholamines were administered at the discretion of the physician; a combined inotropic drug score was calculated for each patient to account for differences in baseline medications among treatment groups. 2,14 The primary end point was a composite variable consisting of death or the development of LCOS requiring additional pharmacological or other support administered within the first 36 hours after receiving study drug. LCOS was defined as clinical signs or symptoms (eg, tachycardia, oliguria, poor perfusion, or cardiac arrest) with or without a widened arterial-mixed venous oxygen saturation difference or metabolic acidosis.…”

“…In 1975, Parr et al 1 reported that nearly 25% of young children had a cardiac index of Ͻ2.0 L/min per m 2 postoperatively as measured by dye dilution, and this finding was a predictor of acute cardiac death. Similarly, Wernovsky et al 2 reported that 25% of neonates with transposition of the great arteries who underwent an arterial switch operation had a decline in cardiac index to Ͻ2.0 L/min per m 2 , typically occurring between 6 and 18 hours after surgery. This fall in cardiac index was associated with an elevated systemic vascular resistance of Ϸ25% and a rise in pulmonary vascular resistance of nearly 40% from baseline values.…”

Heat shock protein 27 is increased in cyanotic tetralogy of Fallot myocardium and is associated with improved cardiac output and contraction

“…Early and late morbidity is related to the function of the right heart which is exposed to increased pressure pre-and post-operatively. A larger VSD and outflow tract obstruction subject the right ventricle to chronic pressure overloading prior to surgery resulting in compromised function and slower recovery after repair (Wernovsky et al 1995). Abnormal post-operative load within the ventricle which can be due to residual lesions or pulmonary regurgitation can lead to right ventricle dilation, right heart failure, conductance disturbance, dysrhythmias and sudden death.…”

Impact of balloon atrial septostomy in neonates with transposition of great arteries

“…For assessing the effects of BAS, clinical and ventilatory variables were assessed over a 4-h period at three points in time, (1) at presentation, (2) 24 h after BAS and (3) immediately before surgical repair. Respiratory severity scores (RSSs) and modified inotropic score were calculated using standard formulae (mean airway pressure  fraction of inspired oxygen) and 19,20 BAS was performed either in the catheterization laboratory, which is in close proximity to our Neonatal Intensive Care Unit or at the bedside by pediatric interventional cardiologists. During the earlier part of the study, a preoperative angiography was often performed in infants with TGA to delineate specific coronary artery anatomy in the catheterization laboratory and BAS was performed during the same procedure.…”