Anesthesia for Congenital Heart Disease

✍ Scribed by Dean B. Andropoulos (editor), Emad B. Mossad (editor), Erin A. Gottlieb (editor)

• Publisher: Wiley-Blackwell
• Year: 2023
• Tongue: English
• Leaves: 1071
• Edition: 4
• Category: Library

✦ Synopsis

Anesthesia forCongenital Heart Disease

An Extensive Reference Work Detailing the Procedures, Knowledge, and Approaches in Anesthesia for Congenital Heart Disease

In this fourth edition of Anesthesia for Congenital Heart Disease, a distinguished group of expert authors in congenital heart disease (CHD) from all over the world provide a thorough, comprehensive, and fully updated overview of the specifics of congenital heart disease and the intricacies involved with administering anesthetic care to patients who suffer from the myriad of lesions encompassed by CHD.

In the seven years since the third edition of Anesthesia for Congenital Heart Disease was published, an explosion of new procedures, approaches, and patients eligible for anesthetic care has occurred. The goal of Anesthesia for Congenital Heart Disease, Fourth Edition is to help readers understand all of the recent advancements and developments in the field while also imparting a foundation of essential historical knowledge. The book contains new chapters that reflect exciting new approaches in this rapidly changing field, and also includes:

• Updated information in the chapter Adult Congenital Heart Disease and Mechanical Support of the Circulation, reflecting the increasing prominence of these patients in CHD care
• New chapters on Informatics and Artificial Intelligence, Genetic Syndromes, Point of Care Ultrasound, and Cardiopulmonary Resuscitation in Congenital Heart Disease
• Thorough updates of all chapters with many new figures and tables, and hundreds of new recent references provide up to date information

Anesthesia for Congenital Heart Disease, Fourth Edition serves as a thorough and in-depth reference work and is an essential resource for practitioners providing perioperative care to CHD patients.

✦ Table of Contents

Cover
Title Page
Copyright Page
Contents
List of Contributors
Preface to the Fourth Edition
List of Abbreviations
About the Companion Website
CHAPTER 1 History of Anesthesia for Congenital Heart Disease
Introduction
The first years: 1938–1954
The heart–lung machine: 1954–1970
Deep hypothermic circulatory arrest and the introduction of PGE1: 1970–1980
PDA and the introduction of PGE1
The story of HLHS: 1980–1990
Fontan and the catheterization laboratory: 1990–2000
Emergence of new technology – imaging (TEE, MRI) and ECMO: 2000–2010
2011–2021 and the future
Congenital heart disease – a growing specialty from the fetus to the adult patient
Acknowledgments
Selected references
CHAPTER 2 Education for Anesthesia in Patients with Congenital Cardiac Disease
Introduction
Why teach and learn congenital cardiac anesthesia?
The current model
Pediatric cardiac anesthesia training
Problem identification and general needs assessment
Targeted needs assessment
Goals and objectives
Educational strategies
Implementation
Evaluation and feedback
Curriculum maintenance and enhancement
Dissemination
Role of professional societies
Conclusion
Acknowledgments
Selected references
CHAPTER 3 Quality, Outcomes, and Databases in Congenital Cardiac Anesthesia
Introduction
Errors and outcomes in surgery and anesthesia
The six “Cs”: communication and teamwork
Databases in pediatric cardiac surgery and anesthesiology
Prospective risk assessment in pediatric cardiac surgery and cardiology
Closed claims analysis in anesthesia
Pediatric and congenital cardiac anesthesia morbidity and mortality
Congenital Cardiac Anesthesia Society and the Congenital Cardiac Anesthesia Network
Joint CCAS–STS database initiative
International efforts
Selected references
CHAPTER 4 Multidisciplinary Collaboration, Team Functioning, and Communication in Congenital Cardiac Care
Introduction
Texas Children’s Heart Center multidisciplinary approach
Heart Center leadership structure
Clinical decision-making
Heart Center Quality Improvement Conferences
Heart Center Wide Communication Activities
Anesthesiologist involvement in patient care and leadership activities
Communication and team functioning in periprocedural areas: surgery and catheterization laboratory
Communication in the operating room
Communication during the operation
Other intraoperative multidisciplinary collaborations
Intensive care unit handoffs
The cardiac catheterization laboratory
Enhanced recovery after cardiac surgery
TCH handbook
Parent and family involvement in congenital cardiac care
Heart Center functioning during the COVID-19 pandemic
Conclusions
Selected references
CHAPTER 5 Informatics and Artificial Intelligence in Congenital Heart Disease
Introduction
History of medical informatics
Principles, terminology, and technologies
How to work with big data
How is data represented
Data types within a hospital
Databases, data organization, and querying data
Data analysis and processing pipelines
Machine learning and artificial intelligence
Supervised learning algorithms
Unsupervised learning algorithms
Deep learning algorithms
Advanced monitors in intensive care units and operating rooms
Limitations and challenges
Future of clinical informatics in congenital heart disease
Selected references
CHAPTER 6 Development of the Cardiovascular System
Introduction
Contemporary concepts of cardiac development
Cardiovascular development: normal and abnormal
Cardiogenic fields
Formation of the heart tube
Cardiac looping
Cardiac septation
Epicardium and coronary artery development
Development of the conduction system
Development of the aortic arches
Development of the pulmonary and systemic veins
Development of cardiac innervation
Development of the cardiac lymphatics
Summary
Selected references
CHAPTER 7 Nomenclature and Anatomic Evaluation in Congenital Heart Disease
Introduction
Congenital heart surgery nomenclature and database project
Approaches for describing congenital heart disease
The “Van Praaghian” and “Andersonian” nomenclature systems
The Van Praagh notation
Segmental approach to diagnosis of congenital heart disease
Cardiac position and apex orientation
Visceral and atrial situs
Great veins and atria
Ventricles and ventricular septum
Atrioventricular junction
Atrioventricular valves
Atrioventricular connections
Ventriculoarterial junction
Conal or infundibular anatomy
Semilunar valves
Ventriculoarterial connections
Great arteries and their relationships
Branch pulmonary arteries and ductus arteriosus
Aortic arch
Coronary arteries
Description of associated malformations
Summary
Selected references
CHAPTER 8 Genetic Syndromes and Associations in Congenital Heart Disease
Introduction
Chromosome 22q11 deletion syndrome
Trisomy 21
Trisomy 18 and 13
Williams-Beuren syndrome and Elastin arteriopathies
Noonan syndrome
Turner syndrome
Goldenhar syndrome
Mucopolysaccharidoses and glycogen storage diseases
Aortopathy syndromes
Marfan syndrome
Loeys-Dietz syndrome
Ehlers-Danlos syndrome
VACTERL association
CHARGE syndrome
Heterotaxy syndrome
Table of genetic syndromes and associations
Genetic testing in CHD
Chromosomal microarray (CMA)
Fluorescence in-situ hybridization (FISH)
Chromosomal karyotype
Single gene sequencing
Whole exome sequencing
Ethics in congenital heart disease
Ethical considerations for treatment
Palliative care in CHD
Conclusions
Selected references
CHAPTER 9 Physiology and Cellular Biology of the Developing Circulation
Introduction
Development from fetus to neonate
Circulatory pathways
Myocardial contractility
Development from neonate to older infant and child
Gene expression in cardiac development
The extracellular matrix
Cell-to-cell connectivity
Innervation of the heart
Development from child to adult
Normal values for physiologic variables by age
Myocardial sequelae of longstanding CHD
Cardiomyocyte receptor function in normal and diseased hearts
The adrenergic receptor
Developmental changes in adrenergic receptor signaling
Developmental changes in calcium cycling
Thyroid hormone
Regulation of vascular tone in systemic and pulmonary circulations
Pulmonary circulation
Systemic circulation
Receptor signaling in myocardial dysfunction, CHD, and heart failure
Receptor signaling in acute myocardial dysfunction
Receptor signaling in CHD
Receptor signaling in congestive heart failure and cardiomyopathy
Myocardial preconditioning
Stem cell and other cell-based therapy for congenital heart disease
Selected references
CHAPTER 10 Anesthetic Agents and Their Cardiovascular Effects
Introduction
Volatile agents
Nitrous oxide (N2O)
Opioids and benzodiazepines
Propofol
Ketamine
Etomidate
Dexmedetomidine
Neuromuscular blocking agents and antagonists
Succinylcholine
Pancuronium
Vecuronium
Rocuronium
Atracurium and cisatracurium
Antagonists
Special conditions affecting anesthetic pharmacokinetics and pharmacodynamics in congenital cardiac anesthesia
Intracardiac shunts
Cardiopulmonary bypass
Hypothermia
Selection of anesthetic regimen in CHD
Selected references
CHAPTER 11 Cardiopulmonary Bypass
Introduction
Basic bypass circuit setup
Cannulation and tubing
Pumps
Oxygenator
Priming
Differences between pediatric and adult CPB
Hemodilution
Perfusion pressures
Flow rates
Aortopulmonary collaterals
Temperature ranges
Glucose management
Management of pediatric CPB
Stages of CPB
Pre-bypass period
Anticoagulation and hemostatic management
Initiation of CPB and flow requirements
Cooling and temperature management
Aortic cross-clamping, myocardial ischemia, and protection
Induction and maintenance of cardioplegic cardiac arrest
Reperfusion
Separation from CPB and post-bypass phase
Conventional ultrafiltration and modified ultrafiltration
Failure to separate from CPB
Heparin reversal and transfusion management
Antifibrinolytic therapy
Effects of CPB on organ systems
Neurological injury and protection
Pulmonary effects
Renal, hepatic, and gastrointestinal effects
Endocrine and metabolic response to CPB
Special CPB management issues
Warm CPB
Deep hypothermic circulatory arrest
Regional cerebral perfusion
Blood gas management: pH-stat vs. alpha-stat
Sickle cell disease
Cold agglutinins
Leukoreduction and irradiation of blood products
Monitoring anticoagulation during and after CPB
Complications and safety
Emergency cardiopulmonary bypass
Conclusions and future perspectives
Selected references
CHAPTER 12 Multiorgan Effects of Congenital Cardiac Surgery
Introduction
The systemic response to congenital cardiac surgery
Systems mediating the systemic inflammatory response to CPB
Mitigating the deleterious effects of CPB
Corticosteroids
Modified ultrafiltration
Protease inhibitors
Biocompatible CPB circuits
Clinical effects of congenital heart surgery on hemostasis and thrombosis
Unique aspects of pediatric coagulation
Hemostasis in congenital heart disease
Risk factors for hemorrhagic complications in pediatric cardiac surgery
Transfusion, inflammation, and outcomes
Transfusion in pediatric cardiac surgery
Antifibrinolytics in pediatric cardiac surgery
MUF in pediatric cardiac surgery
Other methods to minimize transfusion
Other hemostatic agents
Thrombosis in pediatric cardiac surgery
Risk factors for thrombosis in children with CHD
Pulmonary effects of congenital heart surgery
Neonatal and pediatric pulmonary physiology: a compromised state
Effects of CPB on pulmonary physiology in children
CPB and lung parenchyma
Techniques to improve respiratory function
Renal effects of congenital heart surgery
Introduction, incidence, and definition of the problem
Emerging biomarkers of renal dysfunction
Association of renal injury with clinical outcomes
Renal failure and renal replacement therapy following cardiac surgery in children
GI and hepatic consequences of cardiac surgery in children
Splanchnic circulation
Endocrine response and pediatric cardiac surgery
Critical illness-related corticosteroid insufficiency
Stress hyperglycemia
The risk of hypoglycemia
Thyroid hormone
Selected references
CHAPTER 13 Vascular Access and Monitoring
Introduction
Venous access
Peripheral venous access
Central venous access
Arterial access
Radial artery
Femoral artery
Brachial artery
Axillary artery
Umbilical artery
Temporal artery
Dorsalis pedis/posterior tibial arteries
Ulnar artery
Arterial cutdown
Ultrasound guidance for vascular access in congenital heart surgery
Sonoanatomy
Ultrasound-guided peripheral vein access
Ultrasound-guided central vascular access
Ultrasound-guided arterial catheterization
Percutaneous PA catheterization
Interpretation of intravascular pressure waveforms
Arterial pressure waveform
Central venous and left atrial waveforms
Newer techniques in pediatric intravascular monitoring
Cardiac output monitoring
Central venous oxygen saturation monitoring
Complications of vascular access
Incidence and risk factors
Thrombosis
Infection
Malposition/perforation
Pneumothorax/hemothorax
Cardiac tamponade
Inadvertent arterial puncture or catheter placement
Arrhythmias
Systemic venous air embolus
Foreign bodies
Complications related to intracardiac catheters
Other complications
Conclusions
Selected references
CHAPTER 14 Neurological Monitoring and Outcome
Introduction
Cerebrovascular physiology during cardiac surgery
Cooling and rewarming
pH-stat vs. alpha-stat blood gas management
Hemodilution and transfusion practices during CPB
Temperature management
Glucose management
Circulatory arrest
Selective cerebral perfusion
Selective cerebral perfusion and flow rates
Neurological monitoring during congenital heart surgery
Electroencephalographic technologies
Transcranial Doppler ultrasound
Monitors of cerebral oxygenation
Monitors of cerebral autoregulation
Anesthetic and sedative neurotoxicity
Longer term neurodevelopmental testing outcomes after congenital heart surgery
Boston circulatory arrest study
Children’s hospital of Philadelphia cohort
Western Canadian study
Hearts and minds study
Milwaukee cohort
Texas children’s hospital cohort
Single ventricle reconstruction trial
International cardiac collaborative on neurodevelopment (ICCON) investigators cohort
Zurich cohort
Conclusions
Does a neuroprotective strategy during CPB improve outcome?
Selected references
CHAPTER 15 Transesophageal and Epicardial Echocardiography in Congenital Heart Disease
Introduction
Indications for TEE in CHD
Contraindications to TEE
TEE hardware
Echocardiographic system
TEE imaging probes
TEE examination in CHD
Structural examination
Three-dimensional TEE
Functional assessment
Hemodynamic evaluation
Applications of TEE in CHD
TEE safety and complications
Evaluation of selected congenital heart defects before and after intervention
Atrial septal defects
Ventricular septal defects
Atrioventricular septal defects
LV outflow obstruction
RV outflow obstruction
Tetralogy of Fallot
Double-outlet right ventricle
Transposition of the great arteries
Congenitally corrected transposition of the great arteries
Truncus arteriosus
Single ventricle
Applications of TEE during mechanical support
Epicardial echocardiography
Summary
Acknowledgments
Selected references
CHAPTER 16 Coagulation, Cardiopulmonary Bypass, and Bleeding
Introduction
Coagulation
Mechanisms of hemostasis
Developmental hemostasis
Influence of congenital heart disease on coagulation
Preoperative considerations
Predictors of bleeding post-CPB
Preoperative laboratory testing
Preoperative anemia
Autologous donation
CPB-associated coagulation changes
Exposure to CPB circuit
Hemodilution and CPB prime
Dilutional anemia
Dilution of coagulation factors
Composition of CPB prime
Anticoagulation
Heparin-induced thrombocytopenia and alternatives to heparin
Ultrafiltration
Management of bleeding
Cell salvage
Use of coagulation tests and transfusion algorithms
Blood transfusion
Whole blood
Red blood cells
Platelet transfusion
Fibrinogen supplementation
Recombinant factor VIIa
Factor concentrates
Pharmacologic therapies
Antifibrinolytics
Desmopressin
Sickle cell disease
Summary
Selected references
CHAPTER 17 Point-of-Care Ultrasound for Congenital Heart Disease Patients
Introduction
What is POCUS?
Pediatric cardiac POCUS
Basic physics of POCUS
Performing cardiac POCUS
Parasternal long-axis view
Parasternal short-axis view
Apical four-chamber view
Subcostal four-chamber and inferior vena cava views
Individual structure assessment using cardiac POCUS
Assessment of the left ventricle
Assessment of the right ventricle
Assessment of pericardial space and early tamponade physiology
Assessment of the atria and valves
Assistance during cardiac arrest
Assistance during central line placement
Specific clinical situations and corresponding limitations
POCUS during assessment of shock
Performing lung POCUS
Structures by artifact visualization
Incorporation of lung ultrasound into anesthesia practice
POCUS training and credentialing
Selected references
CHAPTER 18 Preoperative Evaluation and Preparation
Introduction
The patient with congenital heart disease
Terminology and classification
Multidisciplinary approach
Consent
Preoperative evaluation
History and physical examination
Congestive heart failure
Pulmonary arterial hypertension
The neonates and premature infants
Medications
Electrocardiographic evaluation, pacemakers, and defibrillators
Laboratory evaluation
Preoperative imaging studies
Chest radiography
Echocardiography
Cardiac catheterization
Magnetic resonance imaging
Computed tomography
Choice of echocardiography, CT, or MRI for non-invasive assessment of CHD
Head ultrasound and other brain imaging modalities
Preoperative preparation
Preoperative fasting
Preoperative psychological preparation and premedication
Infective endocarditis antibiotic prophylaxis
Sickle cell disease
Risk stratification
Selected references
CHAPTER 19 Approach to the Fetus, Premature, and Full-Term Neonate
Approach to treatment in the neonate
Early palliation
Systemic-to-pulmonary artery shunt
Transcatheter ductus arteriosus stent
Banding of the pulmonary artery
The case for early complete repair
Special considerations for the neonate
Limited physiologic reserve
Stress response
Systemic inflammatory response to CPB
Neurologic injury
Premature infants and low birth weight neonates
Pulmonary function
Cardiac function
Necrotizing enterocolitis
Intraventricular hemorrhage
Outcome after congenital heart surgery
Patent Ductus arteriosus occlusion in premature neonates
Fetal cardiac intervention
Transplacental pharmacotherapy of the fetus
Open fetal cardiac interventions
Catheter-based fetal cardiac interventions
Delivery room emergencies in complex congenital heart disease
Selected references
CHAPTER 20 Anesthesia for Adults with Congenital Heart Disease
Introduction
Noncardiac sequelae of CHD
Pulmonary sequelae
Hematological sequelae
Renal sequelae
Neurological sequelae
Hepatic sequelae
Vascular access considerations
Unrestricted shunts
Pregnancy
Relevant physiologic changes during pregnancy
Cardiac risk assessment before and during pregnancy
Maternal obstetric and fetal risks
Care during pregnancy
Cardiac procedures during pregnancy
Delivery planning
Adults with down syndrome
Psychological issues
Cardiac lesions
Atrial septal defects and Shunts
Ventricular septal defect (VSD)
Patent ductus arteriosus
Coarctation of the Aorta
Pulmonary valve stenosis (PS)
Tetralogy of Fallot
Pulmonary atresia
Congenitally corrected transposition of the great arteries
Dextro-transposition of the great arteries (D-TGA)
Ebstein’s anomaly
Single-ventricle anatomy/Fontan physiology
Heart failure in ACHD
Noncardiac surgery in the adult with CHD
Conclusions
Selected references
CHAPTER 21 Hemodynamic Management
Introduction: Hemodynamic management following congenital heart disease surgery: a goal-directed approach
The VO2/DO2 balance following CHD surgery
Mechanisms underlying increases in VO2 following CHD surgery
Mechanisms underlying reduced DO2 following CHD surgery
Improving postoperative oxygen transport balance: preventive and therapeutic interventions
Inotropic agents
Vasoconstrictors
Systemic vasodilators
Pulmonary vasodilators
Other strategies to improve circulatory function
Current practices
Inotropic and vasoactive scores
Individualized perioperative hemodynamic management
Cardiopulmonary interactions
Effects of changes in intrathoracic pressure
Individualized management of the ventilation parameters and cardiopulmonary interactions
Monitoring
Clinical hemodynamic variables and standard perioperative monitoring
Assessment of cardiac output
Near infra-red spectroscopy
Mixed venous saturation
Blood lactate
Central venous to arterial CO2 difference
Current practices
Conclusion
Selected references
CHAPTER 22 Arrhythmias: Diagnosis and Management
Introduction
Cardiac rhythm disturbances
Sinus bradycardia
Low atrial rhythm
Sinus node dysfunction
Sinus tachycardia
Junctional rhythm
Conduction disorders
Supraventricular arrhythmias
Ventricular arrhythmias
Pharmacologic therapy of cardiac arrhythmias
Class I agents
Class IA agents
Class II agents
Class III agents
Class IV agents
Other agents
Pacemaker therapy in children
Pacemaker nomenclature
Permanent cardiac pacing
Temporary cardiac pacing
External cardiac (transcutaneous) pacing
Transesophageal overdrive pacing
Implantable cardioverter-defibrillators
Summary
Selected references
CHAPTER 23 Airway and Ventilatory Management
Introduction
Choosing the appropriate endotracheal tube (ETT)
Orotracheal vs. nasotracheal intubation
The difficult airway
Intubation of the patient with a difficult airway
Fiberoptic-guided tracheal intubation
Emergency cricothyrotomy
The difficult extubation
Airway and ventilatory management for thoracic surgery
Ventilation / perfusion in the lateral decubitus position
Single-lung ventilation (SLV)
Ventilatory management during thoracic surgery
Changes in lung function in children with CHD
Changes in lung function from CPB
Cardiopulmonary interactions
Mechanical ventilation for children with CHD
Lung management during CPB
Volume control vs. pressure control ventilation
Monitoring ventilation
Anesthesia ventilators
Operating room to ICU transition
Specialized problems
Hypoxic gas mixture and inspired CO2
Nitric oxide
Tracheostomy in congenital heart disease
Placement of tracheostomy tubes
Cardiac surgery in patients with pre-existing tracheostomy
Summary
Selected references
CHAPTER 24 Early Tracheal Extubation, Enhanced Recovery After Pediatric Cardiac Surgery, Regional Anesthesia and Postoperative Pain Management
Introduction
Background and history
Enhanced recovery after pediatric cardiac surgery
Feasibility of fast-tracking in congenital heart surgery
Patient selection
Implementation and maintaining fast-tracking
Anesthesia technique
Surgery and CPB considerations
Failed extubation and prolonged mechanical ventilation
Benefits of fast-tracking
Concerns and safety of fast-tracking
Postoperative considerations
Neuraxial techniques
Single-shot neuraxial techniques
Catheter-based neuraxial techniques
Potential benefits of neuraxial techniques
Risks and complications of neuraxial techniques
Regional blocks
Conclusions
Selected references
CHAPTER 25 Cardiopulmonary Resuscitation in the Patient with Congenital Heart Disease
Epidemiology
Overview of current CPR guidelines
CPR techniques
Advanced airway interventions during CPR
Drug administration during CPR
Management of ventricular fibrillation and/or pulseless ventricular fibrillation
Pediatric resuscitation in patients with suspected or confirmed COVID-19 infection
Phases of cardiac arrest
Post-cardiac arrest care
Cardiopulmonary resuscitation for the congenital heart disease patient
Left-heart lesions
The underlying disease states
Adjunctive CPR techniques for the CHD patient
Simulation/education
Team training
Selected references
CHAPTER 26 Anesthesia for Left-to-Right Shunt Lesions
Introduction
Patent ductus arteriosus
Incidence, anatomy, and natural history
Pathophysiology
Surgical and transcatheter approaches and outcomes
Anesthetic considerations
Aortopulmonary window
Incidence, anatomy, and natural history
Pathophysiology
Surgical and transcatheter approaches and outcomes
Anesthetic considerations
Atrial septal defects
Incidence
Anatomy
Natural history
Pathophysiology
Surgical and transcatheter approaches and outcomes
Anesthetic considerations
Ventricular septal defects
Incidence
Anatomy
Natural history
Pathophysiology
Surgical and transcatheter approaches and outcomes
Anesthetic considerations
Atrioventricular canal
Incidence
Anatomy
Natural history
Pathophysiology
Surgical approaches and outcomes
Anesthetic considerations
Double outlet right ventricle
Incidence
Anatomy
Natural history and pathophysiology
Surgical approaches and outcomes
Anesthetic considerations
Truncus arteriosus
Incidence
Anatomy
Natural history
Pathophysiology
Surgical and transcatheter approaches and outcomes
Anesthetic considerations
Partial and total anomalous pulmonary venous return
Incidence
Anatomy
Natural history and pathophysiology
Partial anomalous pulmonary venous return
Total anomalous pulmonary venous return
Surgical approaches and outcomes
Anesthetic considerations
Selected references
CHAPTER 27 Anesthesia for Left–sided Obstructive Lesions
Introduction
Aortic valve stenosis
Incidence, anatomy, and natural history
Pathophysiology
Surgical and transcatheter approaches and outcomes
Anesthetic considerations
Subvalvular AS
Incidence, anatomy, and natural history
Pathophysiology
Surgical and transcatheter approaches and outcomes
Anesthetic considerations
Supravalvular AS
Incidence, anatomy, and natural history
Pathophysiology
Surgical and transcatheter approaches and outcomes
Anesthetic considerations
Hypertrophic cardiomyopathy
Incidence, anatomy, and natural history
Pathophysiology
Surgical and transcatheter approaches and outcomes
Anesthetic considerations
Coarctation of the aorta
Incidence, anatomy, and natural history
Pathophysiology
Surgical and transcatheter approaches and outcomes
Anesthetic considerations
Interrupted or hypoplastic aortic arch
Incidence, anatomy, and natural history
Pathophysiology
Surgical and transcatheter approaches and outcomes
Anesthetic considerations
Shone’s anomaly
Incidence, anatomy, and natural history
Pathophysiology
Surgical and transcatheter approaches and outcomes
Anesthetic considerations
Mitral stenosis
Incidence, anatomy, and natural history
Pathophysiology
Surgical and transcatheter approaches and outcomes
Anesthetic considerations
Cor triatriatum
Selected references
CHAPTER 28 Anesthesia for Right-Sided Obstructive Lesions
Introduction
Ebstein anomaly
Incidence, anatomy, and natural history
Pathophysiology
Surgical and transcatheter approaches and outcomes
Anesthetic considerations
Tetralogy of Fallot
Incidence, anatomy, and natural history
Pathophysiology
Surgical and transcatheter approaches and outcomes
Anesthetic considerations
Pulmonary stenosis with intact ventricular septum
Incidence, anatomy, and natural history
Pathophysiology
Surgical and transcatheter approaches and outcomes
Anesthetic considerations
Pulmonary atresia with intact ventricular septum
Incidence, anatomy, and natural history
Pathophysiology
Surgical and transcatheter approaches and outcomes
Anesthetic considerations
Pulmonary atresia/ventriculoseptal defect/major aortopulmonary collateral arteries
Incidence, anatomy, and natural history
Pathophysiology
Surgical and transcatheter approaches and outcomes
Anesthetic considerations
Summary
Acknowledgements
Selected references
CHAPTER 29 Anesthesia for Transposition of the Great Arteries
Introduction
Physiologically uncorrected TGA
Incidence
Anatomy
Coronary artery anatomy
Natural history and pathophysiology
Shunting and effective pulmonary and systemic blood flow in TGA
Intercirculatory mixing
Clinical presentation and diagnostic features
Outcomes from balloon atrial septostomy
Anesthesia for balloon atrial septostomy
Surgical options
Indication and timing of ASO
Arterial switch operation
Other surgical procedures
Outcomes for ASO
Anesthetic considerations and perioperative management
Congenitally corrected TGA (L-TGA)
Incidence
Anatomy
Natural history
Pathophysiology
Clinical presentation and diagnostic features
Surgical options
Outcomes
Anesthetic considerations and perioperative management
Preoperative assessment
Postoperative course and complications
Selected references
CHAPTER 30 Anesthesia for the Patient with a Single Ventricle
Introduction
Hypoplastic left heart syndrome
Incidence, anatomy, and natural history
Pathophysiology of HLHS
Surgical and transcatheter approaches and outcomes
Anesthetic considerations
Tricuspid atresia
Incidence, anatomy, and natural history
Pathophysiology of TA
Surgical and transcatheter approaches and outcomes
Anesthetic considerations
Other forms of univentricular hearts
Double inlet ventricle
Mitral atresia with VSD
Unbalanced complete atrioventricular septal defect
Single functional ventricle with heterotaxy syndrome
Superior cavopulmonary connection
Surgical procedure
Anesthetic considerations
Outcomes
Fontan completion
Surgical procedure
Anesthetic considerations
Long term complications and outcomes
Transplantation for single-ventricle patients
Heart transplantation
Post-Fontan heart-liver transplantation
Non-cardiac surgery and anesthesia for the patient with a single ventricle
Summary
Selected references
CHAPTER 31 Anesthesia for Miscellaneous Cardiac Lesions
Introduction
Vascular rings
Classification, anatomy, and incidence
Diagnosis of vascular rings
Vascular rings due to double and right aortic arches: anatomy and natural history
Innominate artery compression of the trachea: anatomy, diagnosis, and natural history
Pulmonary artery sling with tracheal stenosis: anatomy and natural history
Anomalies of the coronary arteries
Anomalous pulmonary origins of the coronary arteries: incidence, anatomy, and natural history
Anomalous aortic origins of the coronary arteries
Congenital atresia of the left main coronary artery
Coronary arteriovenous fistulas: incidence, anatomy, and natural history
Coronary artery bridging, aneurysms, and stenosis
Pericardial effusion and tamponade
Incidence, anatomy, and natural history
Pathophysiology and diagnosis of cardiac tamponade
Surgery for pericardial effusion and cardiac tamponade
Anesthesia for pericardial effusion and cardiac tamponade
Mitral regurgitation
Incidence, anatomy, and natural history of mitral regurgitation
Normal anatomy and function of the mitral valve
Classification of mitral regurgitation
Mechanisms of mitral valve regurgitation
Pathophysiology of MR
Surgical approaches and outcomes for MR in children
Anesthetic considerations for the repair of MR
Cardiac tumors in childhood
Incidence, anatomy, and natural history
Pathophysiology of cardiac tumors
Surgical approaches and outcomes for cardiac tumors
Anesthesia considerations for cardiac tumors
Aortic aneurysm and aortopathy in children
Classification and definition of aortic aneurysms (and aortopathy)
Incidence, anatomy, and natural history of aortic aneurysms in children
Genetic conditions associated with aortic aneurysm
Sinus of Valsalva aneurysms
Aortopathy and aortic dilation with CHD
Pathophysiology of aortic aneurysms
Surgical approaches for aortic aneurysms in children
Anesthesia for aortic aneurysm surgery
Mediastinal masses
Incidence, anatomy, and natural history of mediastinal masses in children
Diagnosis of anterior mediastinal masses
Pathophysiology
Surgery for anterior mediastinal masses
Anesthesia for patients with an anterior mediastinal mass
Selected references
CHAPTER 32 Anesthesia for Cardiac and Pulmonary Transplantation
Heart transplantation
Diagnostic indications for heart transplantation
ABO-incompatible heart transplantation
Recipient evaluation
Recipient pretransplant management
Donor management
Surgical technique
Anesthetic management
Failing Fontan transplants
Combined heart and liver transplantation
Heart–lung transplantation
Immunosuppression
Anesthetic management of children who have undergone heart transplantation
Future prospects
Pediatric lung transplantation
Indications, contraindications, and listing criteria in children
Lung transplant listing criteria
Donor management and lung preservation
Bridge to transplantation
Anesthetic management and surgical approach
Immediate perioperative complications
Primary graft failure
Physiological changes and growth of the transplanted lungs
Surgical complications
Medical complications
Selected references
CHAPTER 33 Anesthesia for Pulmonary Hypertension
Incidence, anatomy, natural history
Definition
Classification
Epidemiology
Pathophysiology of pulmonary hypertension in congenital heart disease
Assessment of pulmonary hypertension
Medical management of pulmonary hypertension
Calcium channel blockers (CCBs)
Prostanoids
Endothelin receptor antagonists (ERA)
Phosphodiesterase-5 inhibitors (PDE-5i)
Atrial septostomy and lung transplantation
Perioperative risk considerations
Pulmonary hypertensive crisis
Anesthetic management
Hemodynamic effects of anesthetic drugs
Perioperative pulmonary vasodilators
Airway and ventilation management
Monitoring
Postanesthesia disposition
Conclusions
Selected references
CHAPTER 34 Anesthesia for the Cardiac Catheterization Laboratory
Introduction
Diagnostic catheterization
Procedure overview
Endomyocardial biopsy
Pulmonary hypertension study
Cardiac magnetic resonance imaging-guided catheterization
Interventional catheterization
Device closure of cardiovascular communications
Balloon dilation of cardiac valves
Balloon angioplasty and/or stent placement
Creation of cardiovascular communications
Transcatheter valve replacement
Hybrid procedures
Pericardiocentesis
Percutaneous mechanical circulatory support
Adverse events
Risk assessment
Anesthetic management
Operator-directed sedation versus anesthesia care
Periprocedural planning
Anesthetic techniques
Anesthetic drugs
Monitoring
Intravascular volume management
Recovery
Electrophysiology procedures
Electrophysiology studies and ablations
Anesthetic considerations
Anesthetic drugs and the cardiac conduction system
Implantation of pacemakers and defibrillators
Elective cardioversion
Transvenous lead extractions
Conclusions
Selected references
CHAPTER 35 Anesthesia for Noncardiac Surgery and Magnetic Resonance Imaging
Introduction
Risk assessment and stratification
Preoperative preparation for noncardiac surgery
Multidisciplinary planning
Preoperative cardiology visit
Interpretation of imaging and hemodynamics
Nil per os
Continuation of medications
Endocarditis prophylaxis
Pacemakers and defibrillators
The patient on ventricular assist device support
Management strategies for the stages of single-ventricle palliation
High-risk patient groups
Ductal dependent unpalliated neonates
Shunt-dependent single-ventricle patients
Palliated single-ventricle patients with atrioventricular valve regurgitation
Pulmonary hypertension with systemic or supra-systemic PA pressure
Severe aortic stenosis (peak gradient >60 mmHg)
Williams syndrome
Hypertrophic cardiomyopathy
Transplant coronary artery disease
Eisenmenger syndrome
Adult congenital heart disease
Intraoperative care
Monitoring
Anesthetic technique
Surgery
Complex surgical situations
Radiologic procedures
Magnetic resonance imaging and computed tomography
Lymphatic mapping and intervention
Postoperative considerations
Intensive care unit vs. general inpatient unit
Home discharge criteria
Selected references
CHAPTER 36 Cardiac Intensive Care
Introduction
Pathophysiology of specific congenital cardiac defects and implications
Intercirculatory mixing, complete mixing, and streaming
Shunts
Outflow obstruction
Airway and ventilation management
Airway management
Mechanical ventilation
Cardiorespiratory interactions
Influence of lung volume
Influence of intrathoracic pressure
Positive end-expiratory pressure
Alternative modes of ventilation and respiratory support
Early extubation
Weaning from mechanical ventilation
Myocardial dysfunction and hemodynamic monitoring
Assessment of cardiac output
Surgical factors
Cardiopulmonary bypass and the systemic inflammatory response
Dysrhythmias
Low preload
High afterload
Decreased myocardial contractility
Delayed sternal closure
Cardiopulmonary resuscitation in the cardiac intensive care unit
Prearrest phase: monitoring and event risk reduction
Arrest phase: no-flow and low-flow states
Postresuscitation phase: patient-focused care
Postresuscitation phase: team debriefing
Management of postoperative complications
Patient safety and quality improvement in the cardiac intensive care unit
Mechanical support of the circulation
Extracorporeal membrane oxygenation
Ventricular assist devices
Hemostasis
Infection control
Neurologic monitoring/assessment and complications
Fluid management and renal dysfunction
Nutrition and gastrointestinal complications
SARS-CoV-2 infection and multisystem inflammatory syndrome in children
Selected references
CHAPTER 37 Mechanical Circulatory Support
Background, introduction, and history
Indications for mechanical support
Preoperative stabilization and support
Failure to wean from CPB or LCOS after cardiac surgery
Resuscitation of cardiac arrest
Respiratory failure and lung transplantation
Sepsis
Myocarditis, cardiomyopathy, and cardiac transplantation
Arrhythmias with hemodynamic compromise
Cardiac catheterization instability
Pulmonary hypertension
Intoxicants
Mechanical support to assist organ donation
Contraindications to mechanical support in children
Devices
Extracorporeal membrane oxygenation (ECMO)
Ventricular assist devices
Role of echocardiography in mechanical support
Extracorporeal membrane oxygenation
Ventricular assist devices
Weaning from circulatory support
ECMO weaning
VADs: weaning from CPB to VAD
VADs: weaning from VAD to recovery
Anesthesia, analgesia, and sedation for mechanical support
Drug disposition changes on mechanical support
Anesthesia, analgesia, and sedation for mechanical support patients undergoing NonCardiac surgery
Preoperative management
Intraoperative management
Postoperative management
Anticoagulation, antifibrinolytics, and platelet antiaggregation therapies
Anti-infective therapy
Outcomes and complications of extracorporeal support
ECMO for cardiac support
ECMO for respiratory support
ECMO complicated by sepsis
Overall long-term survival
Neurological outcome
Quality of life
Comparing outcomes and complications of VAD and ECMO
Other outcome issues
The future
Tomorrow ECMO
Tomorrow VAD
Selected references
Appendix: Pediatric Cardiovascular Anesthesia Drug Sheet (September 2022)
References
Index
EULA