Pulmonary Complications After Congenital Heart Surgery

Abstract

Pulmonary complications are the most common causes of morbidity and mortality in the postoperative period after congenital heart surgery. In this review we discuss the diverse pathological mechanisms that contribute to these pulmonary complications. Both mechanical and gas exchange abnormalities result in increased ventilatory requirements, ICU stay and mortality. Parenchymal lung disease can be caused by a variety of conditions including nosocomial pneumonia, atelectasis and use of cardiopulmonary bypass. Direct surgical trauma to the respiratory system can result in diaphragmatic paralysis, chylothorax, subglottic stenosis or vocal cord paralysis. Disturbances in the pulmonary vasculature can also trigger complications including pulmonary embolism, plastic bronchitis and even pulmonary hypertensive crises in certain at risk populations. Close monitoring with early detection and treatment of complications often prevents prolonged ventilation and hospitalization, e.g., cases of chylothorax where early intervention is beneficial. However, the therapies used to manage some of these complications in the pediatric population are nonspecific and varied e.g., therapies for postoperative atelectasis or treatment of plastic bronchitis. There is a paucity of studies that directly address therapy for many of these complications and more randomized controlled trials in the pediatric population are needed.