Perfusion for Congenital Heart Surgery

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

Cor triatriatum, 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