By Andropoulos, Dean B
This well timed revision displays the quick advances in surgical procedure and anesthesia for congenital middle affliction that experience happened in recent times, together with neonatal cardiac surgical procedure and anesthesia, remedy of unmarried ventricle sufferers, new diagnostic modalities, and advancements within the catheterization laboratory. New chapters handle mechanical help of the movement, embryology, and quality/outcomes management.
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Additional info for Anesthesia for congenital heart disease
The introduction of the arterial switch operation again involved anesthesiologists. The initial attempts at arterial switch operations in many institutions resulted in substantial numbers of infants who had severe myocardial ischemia and even frank infarcts. This was due to a variety of problems with the coronary artery transfer and reimplantation into the “switched” aorta that had been moved to the left ventricle outflow tract. Pediatric cardiac anesthesiologists gained extensive experience with intraoperative pressor and inotropic support and nitroglycerine infusions.
Alfred Blalock for the surgical treatment of congenital pulmonary stenosis or atresia. 14 Keats AS, Kurosu Y, Telford J, Cooley DA. Anesthetic problems in cardiopulmonary bypass for open heart surgery. Experiences with 200 patients. Anesthesiology 1958;19:501–14. This is one of the first papers describing the anesthetic problems during bypass, including oxygenation, hypothermia, blood replacement, ventricular fibrillation, atrioventricular block, and pulmonary complications. 25 Greeley WJ, Kern FH, Ungerleider RM et al.
In addition, use of TEE has expanded to the cardiac catheterization laboratory where it is used in parallel with fluoroscopy for device closure of septal defects, allowing confirmation of the placement and location of the device . It has been useful in guiding the mechanical support devices, especially the ventricular assist devices (VAD), confirming cannula placement and the absence of obstruction . The main concerns for the anesthesiologist when using TEE remain airway obstruction, altering left atrial pressure, or even extubating the child in the middle of an operation “under the drapes”.