Peri-operative Care of the Child with Congenital Heart Disease

Abstract

This chapter provides readers with a general clinical framework to peri-operative patient care of children undergoing surgery for congenital heart disease, guiding them through pre-operative patient management, cardiopulmonary bypass and surgery, and post-operative recovery. Initial assessment with use of imaging (echocardiography, CT, MRI) and catheterization to delineate patient anatomy and physiology is vital for patient optimization. The intraoperative factors that can affect the post-operative recovery process are discussed including a practical review of the variations to cardiopulmonary bypass and its numerous physiologic effects. General post-operative issues including hemodynamics, patient monitoring, bleeding, sedation and analgesia, and distal organ disease are reviewed. Discussion of cardiac specific topics include issues related to cardiac function, low cardiac output syndrome, arrhythmias, pacing, the utilization of ECMO and ventricular assist, and factors affecting cardiopulmonary interaction are highlighted. Finally, readers are provided with lesion specific information that can affect post-operative recovery; including residual shunts, pulmonary hypertension, and single ventricle physiology. An emphasis is placed on anticipation of possible issues and early diagnosis to allow for quick and appropriate interventions.