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Postoperative Cardiac Care

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Pediatric Critical Care

Abstract

This chapter is focused on topics relevant to the immediate postoperative care of cardiac surgery patients. Some of these topics are cardiopulmonary bypass, peri-operative monitoring, mechanical ventilation, low cardiac output syndrome, pulmonary arterial hypertension, arrhythmias and management of selected congenital heart defects, chylothorax, diaphragmatic paresis, and vocal cord paresis/ paralysis. The immediate postoperative management of congenital heart disease patients in the intensive care unit can be challenging and requires not only a thorough understanding of cardiovascular pathophysiology but also depends on a multidisciplinary team approach.

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Suggested Reading

  • Abman SH, Hansmann G, Archer SL, Ivy DD, Adatia I, Chung WK, Hanna BD, Rosenzweig EB, Raj JU, Cornfield D, et al. Pediatric pulmonary hypertension: guidelines from the American Heart Association and American Thoracic Society. Circulation. 2015;132:2037–99.

    PubMed  Google Scholar 

  • Alobaidi R, Morgan C, Basu RK, Stenson E, Featherstone R, Majumdar SR, Bagshaw SM. Association between fluid balance and outcomes in critically ill children: a systematic review and meta-analysis. JAMA Pediatr. 2018;172(3):257–68.

    PubMed  PubMed Central  Google Scholar 

  • Aydin SI, Seiden HS, Blaufox AD, Parnell VA, Choudhury T, Punnoose A, Schneider J. Acute kidney injury after surgery for congenital heart disease. Ann Thorac Surg. 2012;94(5):1589–95.

    PubMed  Google Scholar 

  • Backer CL, Eltayeb O, Mongé MC, Mazwi ML, Costello JM. Shunt lesions part I: patent ductus arteriosus, atrial septal defect, ventricular septal defect, and atrioventricular septal defect. Pediatr Crit Care Med. 2016;17(8 Suppl 1):S302–9.

    PubMed  Google Scholar 

  • Ben-Abraham R, Efrati O, Mishali D, Yulia F, Vardi A, Barzilay Z, Paret G. Predictors for mortality after prolonged mechanical ventilation after cardiac surgery in children. J Crit Care. 2002;17(4):235–9.

    PubMed  Google Scholar 

  • Bronicki RA, Hall M. Cardiopulmonary bypass-induced inflammatory response: pathophysiology and treatment. Pediatr Crit Care Med. 2016;17(8 Suppl 1):S272–8.

    PubMed  Google Scholar 

  • Carcillo JA, Podd B, Aneja R, Weiss SL, Hall MW, Cornell TT, Shanley TP, Doughty LA, Nguyen TC. Pathophysiology of pediatric multiple organ dysfunction syndrome. Pediatr Crit Care Med. 2017;18(3_suppl Suppl 1):S32–45.

    PubMed  PubMed Central  Google Scholar 

  • Chang AC, Zucker HA, Hickey PR, Wessel DL. Pulmonary vascular resistance in infants after cardiac surgery: role of carbon dioxide and hydrogen ion. Crit Care Med. 1995;23:568–74.

    CAS  PubMed  Google Scholar 

  • Clancy RR, Sharif U, Ichord R, et al. Electrographic neonatal seizures after infant heart surgery. Epilepsia. 2005;46(1):84–90.

    PubMed  Google Scholar 

  • Cornell TT, Sun L, Hall MW, Gurney JG, Ashbrook MJ, Ohye RG, Shanley TP. Clinical implications and molecular mechanisms of immunoparalysis after cardiopulmonary bypass. J Thorac Cardiovasc Surg. 2012;143(5):1160–6.

    CAS  PubMed  Google Scholar 

  • Cullen S, Shore D, Redington A. Characterization of right ventricular diastolic performance after complete repair of tetralogy of Fallot. Restrictive physiology predicts slow postoperative recovery. Circulation. 1995;91(6):1782–9.

    CAS  PubMed  Google Scholar 

  • Epting CL, McBride ME, Wald EL, Costello JM. Pathophysiology of low cardiac output syndrome. Curr Vasc Pharmacol. 2016;14(1):14–23. Review

    CAS  PubMed  Google Scholar 

  • Geva T, Martins JD, Wald RM. Atrial septal defects. Lancet. 2014;383(9932):1921–32.

    PubMed  Google Scholar 

  • Ghanayem NS, Hoffman GM. Near infrared spectroscopy as a hemodynamic monitor in critical illness. Pediatr Crit Care Med. 2016 Aug;17(8 Suppl 1):S201–6.

    PubMed  Google Scholar 

  • Gilboa SM, Devine OJ, Kucik JE, Oster ME, Riehle-Colarusso T, Nembhard WN, Xu P, Correa A, Jenkins K, Marelli AJ. Congenital heart defects in the United States: estimating the magnitude of the affected population in 2010. Circulation. 2016;134(2):101–9.

    PubMed  PubMed Central  Google Scholar 

  • Gist KM, Kwiatkowski DM, Cooper DS. Acute kidney injury in congenital heart disease. Curr Opin Cardiol. 2018;33(1):101–7.

    PubMed  Google Scholar 

  • Gurvitz M, Burns KM, Brindis R. Et.al. Emerging research directions in adult congenital heart disease: a report from an NHLBI/ACHA working group. J Am Coll Cardiol. 2016;67(16):1956–64.

    PubMed  PubMed Central  Google Scholar 

  • Hassinger AB, Wald EL, Goodman DM. Early postoperative fluid overload precedes acute kidney injury and is associated with higher morbidity in pediatric cardiac surgery patients. Pediatr Crit Care Med. 2014;15(2):131–8.

    PubMed  Google Scholar 

  • Hoffman GM, Ghanayem NS, Scott JP, Tweddell JS, Mitchell ME, Mussatto KA. Postoperative cerebral and somatic near-infrared spectroscopy saturations and outcome in hypoplastic left heart syndrome. Ann Thorac Surg. 2017;103(5):1527–35.

    PubMed  Google Scholar 

  • Hoskote A, Li J, Hickey C, Erickson S, Van Arsdell G, Stephens D, Holtby H, Bohn D, Adatia I. The effects of carbon dioxide on oxygenation and systemic, cerebral, and pulmonary vascular hemodynamics after the bidirectional superior cavopulmonary anastomosis. J Am Coll Cardiol. 2004;44(7):1501–9.

    PubMed  Google Scholar 

  • Huber JN, Hilkin BM, Hook JS, Brophy PD, et al. Neutrophil phenotype correlates with postoperative inflammatory outcomes in infants undergoing cardiopulmonary bypass. Pediatr Crit Care Med. 2017;18(12):1145–52.

    PubMed  Google Scholar 

  • Kaza AK, Thiagarajan RR. Left ventricular outflow tract obstruction: coarctation of the aorta, interrupted aortic arch, and borderline left ventricle. Pediatr Crit Care Med. 2016 Aug;17(8 Suppl 1):S315–7.

    PubMed  Google Scholar 

  • Kozik DJ, Tweddell JS. Characterizing the inflammatory response to cardiopulmonary bypass in children. Ann Thorac Surg. 2006;81(6):S2347–54.

    PubMed  Google Scholar 

  • Kwiatkowski DM, Menon S, Krawczeski CD, Goldstein SL, Morales DL, Phillips A, Manning PB, Eghtesady P, Wang Y, Nelson DP, Cooper DS. Improved outcomes with peritoneal dialysis catheter placement after cardiopulmonary bypass in infants. J Thorac Cardiovasc Surg. 2015;149(1):230–6.

    PubMed  Google Scholar 

  • Kwiatkowski DM, Goldstein SL, Cooper DS, Nelson DP, Morales DL, Krawczeski CD. Peritoneal dialysis vs furosemide for prevention of fluid overload in infants after cardiac surgery: a randomized clinical trial. JAMA Pediatr. 2017;171(4):357–64.

    PubMed  Google Scholar 

  • Laffey JG, Boylan JF, Cheng DC. The systemic inflammatory response to cardiac surgery: implications for the anesthesiologist. Anesthesiology. 2002;97(1):215–52.

    CAS  PubMed  Google Scholar 

  • Lara DA, Lopez KN. Public health research in congenital heart disease. Congenit Heart Dis. 2014;9(6):549–58.

    PubMed  Google Scholar 

  • Leong AY, Field CJ, Larsen BM. Nutrition support of the postoperative cardiac surgery child. Nutr Clin Pract. 2013;28(5):572–9.

    PubMed  Google Scholar 

  • Leow EH, Chan YH, Ng YH, Lim JKB, Nakao M, Lee JH. Prevention of acute kidney injury in children undergoing cardiac surgery: a narrative review. World J Pediatr Congenit Heart Surg. 2018;9(1):79–90.

    PubMed  Google Scholar 

  • Maher KO, Tweddell JS. Aortic and mitral valve disease and left ventricular dysfunction in children. Pediatr Crit Care Med. 2016;17(8 Suppl 1):S131–9.

    PubMed  Google Scholar 

  • Naim MY, Gaynor JW, Chen J, et al. Subclinical seizures identified by postoperative electroencephalographic monitoring are common after neonatal cardiac surgery. J Thorac Cardiovasc Surg. 2015;150(1):169–78.

    PubMed  PubMed Central  Google Scholar 

  • Ohye RG, Sleeper LA, Mahony L, Newburger JW, Pearson GD, Lu M, et al. Comparison of shunt types in the Norwood procedure for single-ventricle lesions. N Engl J Med. 2010;362:1980–92.

    CAS  PubMed  PubMed Central  Google Scholar 

  • Oishi P, Fineman JR. Pulmonary hypertension. Pediatr Crit Care Med. 2016;17:S140–5.

    PubMed  PubMed Central  Google Scholar 

  • Penny DJ, Vick GW 3rd. Ventricular septal defect. Lancet. 2011;377(9771):1103–12.

    PubMed  Google Scholar 

  • Roeleveld PP, Zwijsen EG. Treatment strategies for paradoxical hypertension following surgical correction of coarctation of the aorta in children. World J Pediatr Congenit Heart Surg. 2017;8(3):321–31.

    PubMed  PubMed Central  Google Scholar 

  • Rossano JW, Cabrera AG, Shaddy RE. Heart transplantation-the pediatric cardiac critical care perspective. Pediatr Crit Care Med. 2016;17(8 Suppl 1):S171–7.

    PubMed  Google Scholar 

  • Sano S, Ishino K, Kawada M, Honjo O. Right ventricle-pulmonary artery shunt in first-stage palliation of hypoplastic left heart syndrome. Semin Thorac Cardiovasc Surg Pediatr Card Surg Annu. 2004;7:22–31.

    PubMed  Google Scholar 

  • Seghaye MC, Engelhardt W, Grabitz RG, et al. Multiple system organ failure after open heart surgery in infants and children. Thorac Cardiovasc Surg. 1993;41:49–53.

    CAS  PubMed  Google Scholar 

  • Shah S, Szmuszkovicz JR. Pediatric perioperative pulmonary arterial hypertension: a case-based primer. Children (Basel). 2017;4(10):92.

    PubMed  Google Scholar 

  • Shi S, Zhao Z, Liu X, et al. Perioperative risk factors for prolonged mechanical ventilation following cardiac surgery in neonates and young infants. Chest. 2008;134(4):768–74.

    PubMed  Google Scholar 

  • Tweddell JS, Sleeper LA, Ohye RG, Williams IA, Mahony L, Pizarro C, et al. Intermediate-term mortality and cardiac transplantation in infants with single-ventricle lesions: risk factors and their interaction with shunt type. J Thorac Cardiovasc Surg. 2012;144:152–9.

    PubMed  PubMed Central  Google Scholar 

  • Webb TN, Goldstein SL. Congenital heart surgery and acute kidney injury. Curr Opin Anaesthesiol. 2017;30(1):105–12.

    CAS  PubMed  Google Scholar 

  • Wernovsky G. Transposition of the great arteries and common variants. Pediatr Crit Care Med. 2016;17(8 Suppl 1):S337–43.

    PubMed  Google Scholar 

  • Wernovsky G, Wypij D, Jonas RA, et al. Postoperative course and hemodynamic profile after the arterial switch operation in neonates and infants. A comparison of low-flow cardiopulmonary bypass and circulatory arrest. Circulation. 1995;92(8):2226–35.

    CAS  PubMed  Google Scholar 

  • Wessel DL. Managing low cardiac output syndrome after congenital heart disease. Crit Care Med. 2001;29(10 Suppl):S220–30.

    CAS  PubMed  Google Scholar 

  • Wong JJ, Cheifetz IM, Ong C, Nakao M, Lee JH. Nutrition support for children undergoing congenital heart surgeries: a narrative review. World J Pediatr Congenit Heart Surg. 2015;6(3):443–54.

    PubMed  Google Scholar 

  • Zuluaga MT. Chylothorax after surgery for congenital heart disease. Curr Opin Pediatr. 2012;24(3):291–4.

    PubMed  Google Scholar 

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Correspondence to Orkun Baloglu .

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Baloglu, O., Hanna, W., Hamzah, M. (2021). Postoperative Cardiac Care. In: Lucking, S.E., Maffei, F.A., Tamburro, R.F., Zaritsky, A. (eds) Pediatric Critical Care . Springer, Cham. https://doi.org/10.1007/978-3-030-53363-2_19

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  • DOI: https://doi.org/10.1007/978-3-030-53363-2_19

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  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-030-53362-5

  • Online ISBN: 978-3-030-53363-2

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