Application of ultra short acting beta blockade (esmolol) in pediatric open heart surgery: a trial in total anomalous pulmonary venous return.

Abstract

In the repair of total anomalous pulmonary venous return (TAPVR) under cardiopulmonary bypass, esmolol, ultra short acting beta blocker, was applied to obtain low heart rate and weak ventricular contraction under mild hypothermic cardiopulmonary bypass. Five infants aged from 14 to 158 days with an average of 70 days, underwent a primary or palliative repair of TAPVR. The type of anomalous return was supracardiac type (2), infracardiac (2), and intracardiac (1). A primary repair was done in three for isolated TAPVR with bypass time of 65 to 76 minutes, and a palliative repair for two with complex anomalies with bypass time of 64 and 87 minutes. There was one operative death from cerebral bleeding in an infant with complex TAPVR who underwent simultaneous pulmonary banding. This strategy seems to be applicable in pediatric cardiac surgery when aortic cross-clamping is better to be avoided and the surgery is mainly limited to the atrial level.