tailieunhanh - Ebook Perfusion for congenital heart surgery: Part 2

(BQ) Part 2 book “Perfusion for congenital heart surgery” has contents: Bypass considerations based on diagnosis, notes on select emergency procedures during bypass, brief overview of named procedures and terms, notes on select issues during bypass, recommended reference books, and other contents. | Chapter 6 Bypass considerations based on diagnosis Congenital cardiac defects may or may not present in the prenatal or neonatal periods depending on lesion, severity, and prenatal surveillance. Congenital heart disease may present as feeding intolerance, failure to thrive, ECG abnormalities, murmurs, recurrent respiratory infections or transient cyanosis. For many lesions, early intervention is preferred to prevent pulmonary hypertension and/or ventricular dysfunction leading to congestive heart failure. Some defects are quite incompatible with life (TGA/IVS with restrictive ASD or small PDA) and are repaired within days of birth or diagnosis. Other lesions may go undetected until later in life (L-TGA, ALCAPA) and therefore do not have surgical intervention until much later. Congenital cardiac defects exist over a wide spectrum, and it is important to recognize that each cardiopulmonary bypass plan must take into account the specifics of each planned repair. One of the better examples of how one diagnosis can vary over a wide spectrum is the patient diagnosed with double outlet right ventricle (DORV). On one end of the spectrum, these patients may essentially be a variant of the Tetralogy of Fallot (TOF) diagnosis with repair requiring a well-placed VSD patch (due to the overriding aorta) and perhaps some subpulmonary muscle bundle resection. On the other end of the spectrum, these patients may have transposed great vessels and a VSD. This would require an arterial switch operation and VSD closure. The basic explanations and bypass notes provided in this chapter must therefore be molded to the specific diagnosis, planned surgical procedure, and other pertinent anatomic characteristics to be useful. The perfusionist must review the available diagnostic studies when devising a bypass plan. Certainly, this review should identify the original diagnosis, surgical and cath lab history, planned repair, status of the ductus arteriosus, presence of aortopulmonary .