Perfusion for Congenital Heart Surgery


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Table of Contents

Foreword, x Preface, xi Acknowledgments, xii 1 Equipment for bypass, 1 Oxygenators, 1 Arterial line filters, 12 Tubing packs, 13 Cardioplegia systems, 16 The heart-lung machine, 17 The heater-cooler system, 19 Cannulae, 20 2 Priming the bypass circuit, 27 Prime constituents, 27 Steps for priming, 28 3 The bypass plan, 33 Communication agreement for case, 33 Anticoagulation management, 35 Blood gas management, 40 Carbon dioxide management, 40 Oxygenation strategy, 42 Hematocrit management, 45 Blood pressure management, 47 Temperature management, 49 Flow rates, regional perfusion, and hypothermic circulatory arrest, 52 Methods of ultrafiltration, 55 Before bypass, 55 On bypass, 55 After bypass, 56 SMUF specifications, 59 Standard and augmented venous return, 60 Standard venous return with gravity siphon drainage, 60 Augmented venous return, 60 The prebypass checklist, 63 The surgical safety checklist for congenital heart surgery, 65 4 Typical phases of cardiopulmonary bypass, 72 Commencement of bypass, 72 Standard support phase of bypass, 74 Termination of bypass, 76 Post bypass, 78 5 Additional notes based on bypass tasks, 79 Prebypass, 79 Heart-lung machine (HLM), 79 Reoperations, 79 Cannulation, 79 Transfusion during cannulation, 80 On bypass, 80 Verification of adequate drainage when caval tapes are used, 80 Blood gas management, 80 Cardioplegia delivery, 81 Planned circulatory arrest, 81 Induced ventricular fibrillation, 82 Administration of blood products, 82 Atrial line placement, 82 LV vent placement, 83 Bed rotation during bypass, 83 6 Bypass considerations based on diagnosis, 85 Anomalous coronary arteries, 86 Aortic regurgitation/insufficiency, 89 Aortic stenosis, 91 Aortopulmonary collaterals, 93 Aortopulmonary window, 95 Atrial septal defect, 96 Cardiomyopathy requiring orthotopic heart transplantation, 99 Coarctation of the aorta, 100 Common atrioventricular canal defect, 102 Cortriatriatum, 104 Corrected transposition of the great arteries (L-TGA, Levo-TGA, or C-TGA) or congenitally corrected TGA, 105 Critical aortic stenosis, 107 Double chambered right ventricle, 109 Double inlet left ventricle, 110 Double outlet left ventricle, 111 Double outlet right ventricle, 112 Ebstein's anomaly, 113 Hypoplastic left heart syndrome, 114 Stage 1 (Norwood) procedure, 115 Hybrid stage 1 palliation, 117 Stage 2 or bidirectional Glenn shunt, 117 Fontan procedure (total cavopulmonary anastomosis), 119 Interrupted aortic arch, 121 Left superior vena cava, 123 Lung transplantation, 124 Mitral regurgitation/insufficiency, 125 Mitral stenosis, 126 Patent ductus arteriosus, 127 Pulmonary artery abnormalities, 128 Pulmonary atresia, 129 Pulmonary atresia with an intact ventricular septum, 129 Pulmonary atresia with ventricular septal defect, 130 Pulmonary regurgitation/insufficiency, 132 Pulmonary stenosis, 133 Pulmonary vein stenosis or pulmonary venous obstruction, 134 Tetralogy of Fallot, 136 Total anomalous pulmonary venous return and partial anomalous pulmonary venous return, 138 d-Transposition of the great arteries, 140 Tricuspid atresia, 142 Tricuspid regurgitation/insufficiency, 143 Truncus arteriosus, 144 Ventricular septal defect, 146 7 Notes on select issues during bypass, 148 Blood pressure higher than expected, 148 Blood pressure lower than expected, 149 Bypass circuit pressure higher than expected, 151 Bypass circuit pressure lower than expected, 152 Central venous pressure elevated, 153 Heat exchange issue (slow cooling or warming), 154 NIRS values lower than expected, 155 PaCO2 higher than expected, 157 PaCO2 lower than expected, 159 PaO2 lower than expected, 160 Reservoir volume acutely low, 161 8 Notes on select emergency procedures during bypass, 163 Arterial pump failure (roller head), 164 Failure to oxygenate, 165 Massive air embolization, 166 Acute aortic dissection at the initiation of bypass, 168 Venous air lock, 169 Inadvertent arterial decannulation, 170 Inadvertent venous decannulation, 171 9 Brief overview of named procedures and terms, 172 Alfieri stitch, 172 Batista procedure, 172 Bentall procedure, 172 Bidirectional Glenn shunt, 172 Blalock-Hanlon procedure, 172 Blalock-Taussig shunt (BTS), 173 Brock procedure, 173 Central shunt, 173 Cone procedure, 173 Cox maze procedure, 173 Damus-Kaye-Stansel anastomosis, 173 Double switch procedure, 173 Fontan procedure, 174 Gott shunt, 174 Hemi-Fontan procedure, 174 Holmes heart, 174 Jatene operation, 174 Kawasaki disease, 174 Kawashima procedure, 175 (Diverticulum of) Kommerell, 175 Konno procedure, 175 LeCompte maneuver, 175 LeCompte procedure, 175 Manougian procedure, 175 Marfan's syndrome, 175 Maze procedure, 175 Mustard procedure, 176 Nicks procedure, 176 Nikaidoh procedure, 176 Noonan syndrome, 176 Norwood operation, 176 Pannus, 176 Pentalogy of Cantrell, 176 Potts shunt, 177 Rashkind procedure, 177 Rastelli operation, 177 Ross procedure, 177 Sano shunt, 177 Scimitar syndrome, 177 Senning operation, 177 Shone's complex, 178 Takeuchi procedure, 178 Taussig-Bing anomaly, 178 Trusler repair, 178 Van Praagh classification, 178 Warden procedure, 178 Waterston shunt, 178 Williams syndrome, 178 Yasui procedure, 179 10 Abbreviations for congenital heart surgery, 180 11 Recommended reference books, 186 12 Comprehensive experience-based equipment selection chart select medications administered during bypass, 187 Index, 190

About the Author

Gregory S. Matte Perfusion Clinical Coordinator (Co-Chief) Boston Children s Hospital Boston, MA In addition to coordinating perfusion at Boston Children s,an internationally-recognized children s hospital, Mr. Mattehas extensive experience training clinicians and has writtenextensively in leading journals in the field.

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