Current Problems in Surgery

2010-04-01

Foreword

Stanley W. Ashley — 2010-04-01

In this issue of Current Problems in Surgery, Drs. Avihu Gazit, Charles Huddleston, Paul Checchia, James Fehr, and A. Thomas Pezzella from Washington University in St. Louis complete their two-issue monograph entitled, “Care of the Pediatric Cardiac Surgery Patient.” This issue, part 2, begins with a discussion of outcome prediction and the transition from surgery to postoperative care. Subsequent management, including monitoring and a subsystem approach to the complete care of these patients, is covered in significant detail, including the wide variety of complications that may accompany these complex operations. The monograph concludes with a discussion of special conditions, ranging from single ventricle physiology to pediatric cardiac surgery in developing countries. This thorough review should become an essential resource for all physicians caring for such patients.

In Brief

2010-04-01

Caring for a child with congenital heart disease or acquired heart failure is challenging and requires thorough understanding of normal cardiovascular dynamics, development, anatomy, and physiology. From this, the practitioner can have an understanding of the pathophysiology and natural history of different congenital and acquired cardiac abnormalities. That extensive knowledge is used by multiple team members comprising the care team to optimize the outcome of those children. A team of cardiologists, cardiac surgeons, cardiac anesthesiologists, perfusionists, cardiac intensivists, nurses, and respiratory therapists is necessary to work in concert with the family to care for the child. The journey of a child with complex congenital heart disease starts in utero and continues into adulthood. It is important for the team to realize that the work done in infancy establishes a lifelong relationship with these patients.

Care of the Pediatric Cardiac Surgery Patient—Part 2

2010-04-01

The postoperative care of children undergoing surgery with cardiopulmonary bypass (CPB) is an art that requires expertise in intensive care, thorough understanding of congenital heart disease (CHD) pathophysiology, highly specialized nursing staff, respiratory therapists, and state-of-the-art equipment. Significant challenges are management of the low cardiac output (CO) and systemic inflammatory response following CPB. Another major challenge is the postoperative care of premature and low-weight infants (<2.5 kg) with complex CHD who have a higher mortality risk when compared with children of normal weight with similar defects.

Current Problems in Surgery

Table of Contents

Foreword

In Brief

Care of the Pediatric Cardiac Surgery Patient—Part 2