Early postoperative care of patients with pulmonary hypertension associated with congenital cardiac disease

Abstract

pulmonary vascular bed plays a pivotal role inthe presentation and outcome of the childwith congenital cardiovascular disease. It is in theimmediate postoperative period that the child ismost vulnerable to a sudden or sustained increase inpulmonary vascular resistance. Following surgeryfor congenital cardiac disease, pulmonary vascularreactivity is heightened, and vasospastic stimulusesmay result in sudden increases in pulmonary arterialpressure and resistance, resulting in acute right-sided cardiac failure, tricuspid regurgitation, sys-temic hypotension, myocardial ischaemia, andincreased resistance in the airways. These episodes,called pulmonary hypertensive crises, may be lethalevents. Mildly stimulating events can precipitatesimilar crises, and the crises tend to last longer andcluster.