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Manipulating parallel circuits: the perioperative management of patients with complex congenital cardiac disease

Published online by Cambridge University Press:  24 May 2005

John Lawrenson ,
Benedicte Eyskens ,
Dirk Vlasselaers  and
Marc Gewillig
John Lawrenson
Affiliation:
Departments of Paediatric Cardiology and Intensive Care, Gasthuisberg University Hospital, Catholic University of Leuven, Belgium Current address – Paediatric Cardiology Unit, Red Cross Children's Hospital, University of Cape Town, Cape Town, South Africa
Benedicte Eyskens
Affiliation:
Departments of Paediatric Cardiology and Intensive Care, Gasthuisberg University Hospital, Catholic University of Leuven, Belgium
Dirk Vlasselaers
Affiliation:
Departments of Paediatric Cardiology and Intensive Care, Gasthuisberg University Hospital, Catholic University of Leuven, Belgium
Marc Gewillig
Affiliation:
Departments of Paediatric Cardiology and Intensive Care, Gasthuisberg University Hospital, Catholic University of Leuven, Belgium
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Abstract

In all patients undergoing cardiac surgery, the effective delivery of oxygen to the tissues is of paramount importance. In the patient with relatively normal cardiac structures, the pulmonary and systemic circulations are relatively independent of each other. In the patient with a functional single ventricle, the pulmonary and systemic circulations are dependent on the same pump. As a consequence of this interdependency, the haemodynamic changes following complex palliative procedures, such as the Norwood operation, can be difficult to understand.

Comparison of the newly created surgical connections to a simple set of direct current electrical circuits may help the practitioner to successfully care for the patient. In patients undergoing complex palliations, the pulmonary and systemic circulations can be compared to two circuits in parallel. Manipulations of variables, such as resistance or flow, in one circuit, can profoundly affect the performance of the other circuit. A large pulmonary flow might result in a large increase in the saturation of haemoglobin with oxygen returning to the heart via the pulmonary veins at the expense of a decreased systemic flow. Accurate balancing of these parallel circulations requires an appreciation of all interventions that can affect individual components of both circulations.

Keywords

Congenital cardiac malformationspostoperative carecyanosissurgery
Type
Review
Information
Cardiology in the Young , Volume 13 , Issue 4 , August 2003 , pp. 316 - 322
Copyright
© 2003 Cambridge University Press

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References

Meliones JN, Nichols DG, Wetzel RC, Greeley WJ. Perioperative management of patients with congenital heart disease: a multidisciplinary approach. In: Nichols DG, Cameron DE, Greeley WJ, Lappe DG, Ungerleider RM, Wetzel RC (eds). Critical Heart Disease in Infants and Children. Mosby, St Louis, 1995, pp 553–579.
Dreyer WJ, Mayer DC, Neish SR. Cardiac contractility and pump function. In: Garson A, Bricker JT, Fisher DJ, Neish SR (eds). The Science and Practice of Pediatric Cardiology, 2nd edn. Williams and Williams, Baltimore, 1998, pp 211–230.
Choussat A, Fontan F, Besse P, Vallot A, Chauve A, Bricaud H. Selection criteria for Fontan's procedure. In: Anderson RH, Shinebourne EA (eds). Paediatric Cardiology. Churchill Livingstone, Edinburgh, 1997, pp 559–566.
Rudolph AM. Congenital diseases of the heart. Year Book Medical Publishers, Chicago, 1974, pp 124–125.
Chang AC, Atz AM, Wernovsky G, Burke RP, Wessel DL. Milrinone: systemic and pulmonary hemodynamic effects in neonates after cardiac surgery. Crit Care Med 1995; 23: 1907–1914.Google Scholar
Rudolph AM. Congenital diseases of the heart. Year Book Medical Publishers, Chicago, 1974, pp 577–579.
Gustafson RA, Murray GF, Warden HE, Hill RC, Rozar GE. Stage 1 palliation of the hypoplastic left heart syndrome: the importance of neoaorta construction. Ann Thorac Surg 1989; 48: 43–50.Google Scholar
Barnea O, Santamore W, Rossi A, Salloum E, Chien S, Austin EH. Estimation of oxygen delivery in newborns with a univentricular circulation. Circulation 1998; 98: 1407–1413.Google Scholar
Francis DP, Willson K, Thorne SA, Davies LC, Coats AJS. Oxygenation in patients with a functionally univentricular circulation and complete mixing of blood. Are saturation and flow interchangeable? Circulation 1999; 100: 2198–2203.Google Scholar
Wernovsky G, Chang AC, Wessel DL. Intensive care. In: Emmanouilides GC, Riemenschneider TA, Allen HD, Gutgesell HP (eds). Moss and Adams Heart Disease in Infants, Children and Adolescents, 5th edn. Williams and Wilkins, Baltimore, 1995, pp 398–439.
Tabbutt S, Ramamoorthy C, Montenegro L, et al. Impact of inspired gas mixtures on preoperative infants with hypoplastic left heart syndrome during controlled ventilation. Circulation 2001; 104 [Suppl I]: I-159–I-164.Google Scholar
Bradley S, Simsic J, Atz A. Hemodynamic effects of inspired carbon dioxide after the Norwood procedure. Ann Thorac Surg 2001; 72: 2088–2094.Google Scholar
Riordan CJ, Locher JP, Santamore WP, Villafane J, Austin EH. Monitoring systemic venous oxygen saturations in the hypoplastic left heart syndrome. Ann Thorac Surg 1997; 63: 835–837.Google Scholar
Atz A, Feinstein JA, Jonas RA, Perry SB, Wessel DL. Preoperative management of pulmonary hypertension in hypoplastic left heart syndrome with restrictive atrial septal defect. Am J Cardiol 1999; 83: 1224–1228.Google Scholar
Bove EL, Lloyd TR. Staged reconstruction for the hypoplastic left heart syndrome. Contemporary results. Ann Surg 1996; 224: 387–395.Google Scholar
Mosca RS, Bove EL, Crowley DC, Sandhu SK, Shork MA, Kulik TJ. Hemodynamic characteristics of neonates following first stage palliation for hypoplastic left heart syndrome. Circulation 1995; 92 (Suppl II): II-267–II-271.Google Scholar
Charpie JR, Dekeon MK, Goldberg CS, Mosca RS, Bove EL, Kulik TJ. Postoperative hemodynamics following Norwood palliation for hypoplastic left heart syndrome [abstract]. Circulation 1999; 100 (Suppl I): I-98.Google Scholar
Beghetti M, Morris K, Cox P, Bohn D, Adatia I. Inhaled nitric oxide differentiates pulmonary vasospasm from vascular obstruction after surgery for congenital heart disease. Intensive Care Med 1999; 25: 1126–1130.Google Scholar