Common Surgical Interventions Resulting in Alterations in Hemodynamics
Congenital heart disease is the most common birth defect. In the USA approximately 25,000 newborns with congenital heart disease undergo surgical repair every year. In 2010 the CDC estimated that about one million US children were living with CHD who surgical correction or palliation; about 83% of these children are now surviving long term. It is extremely likely that a clinician will encounter a patient in an Emergency Department (ED) or primary care setting who has undergone a congenital heart operation. The incidence of congenital heart disease is 0.8% of all births and is greater than other more charismatic conditions such as childhood cancers, cystic fibrosis, and juvenile diabetes. In addition, with increasingly successful surgical approaches, there are now more adults with congenital heart disease than children. The relevance of understanding the altered hemodynamics of this patient population was reported in the Journal of Pediatrics by Cashen and colleagues, who interviewed 376 emergency room physicians. A large number (72%) were unsure of the acceptable range of arterial oxygen saturations for infants with single-ventricle physiology, and 58% were uncomfortable about treatment of these infants. A detailed description of all the procedures performed in the field of pediatric cardiovascular surgery is beyond the scope of this chapter. Only the common operations resulting in altered hemodynamics will be discussed.