tailieunhanh - Cardiopulmonary interactions in children with congenital heart disease: physiology and clinical correlates

Global funding for malaria control has risen signiicantly in recent years. The Roll Back Malaria Partnership estimates that interna- tional funding has grown from $250 million in 2004 to $700 million in 2007, with funding expected to have reached $ billion in 2008 alone, due largely to the Global Fund to Fight AIDS, Tuberculosis and Malaria; the World Bank; the . President’s Malaria Initiative and others. 6 Many African countries recently achieved unprecedented success in obtaining Global Fund resources in the latest round of malaria grant applications (box 2). And in 2008, world leaders committed billions more towards malaria control. Indeed, a new. | ELSEVIER Progress in Pediatric Cardiology 11 2000 203-210 Progress in Pediatric Cardiology WWW. el se vi er. com 1 ocate ppedcard Cardiopulmonary interactions in children with congenital heart disease physiology and clinical correlates Keith C. Kocisa U Jon N. Melionesb aDepartment of Pediatrics and Surgery University of Southern California School of Medicine Childrens Hospital Los Angeles MS 66 4650 Sunset Boulevard Los Angeles CA 90027 USA b Department of Pediatrics and Anesthesia Duke Univ ersity Duke Children s Hospital Durham NC USA Abstract Cardiopulmonary interaction is the term that is used to describe the inseparable connection between the heart and lungs. In health the cardiovascular and pulmonary systems are in perfect balance. In disease derangements of either system leads to dysfunction in the other. Physicians attempt to improve health with therapeutic interventions positive pressure ventilation typically aimed at treating disease pneumonia with hypoxia in one system lungs with resultant positive recruitment of alveoli and negative ventilator induced lung injury consequences and secondary impact on the other system heart with decreased cardiac output . This manuscript will review the physiologic basis of normal cardiopulmonary interactions and the pathophysiology that occurs in speci c disease processes affecting children with congenital cardiac disease. Lastly we will present current data highlighting therapeutic interventions aimed at improving cardiopulmonary interactions. 2000 Elsevier Science Ireland Ltd. All rights reserved. Keywords Cardiac output Cardiopulmonary interactions Children Congenital cardiac disease Fontan operation High frequency jet ventilation Intrathoracic pressure Mechanical ventilation Positive pressure ventilation Pulmonary vascular resistance Ventricular interdependence 1. Introduction This chapter will present the concepts involved in determining the complex interactions between the cardiovascular and pulmonary systems. .