Cardiovascular Pediatric Critical Illness and Injury (eBook)

Preface 5
Preface to Pediatric Critical Care Medicine: Basic Science and Clinical Evidence 6
Contents 8
Contributors 10
Chapter 1: Developmental Cardiac Physiology 13
Cardiomyocytes 13
A Primer on Cardiac Embryology 13
Autonomic Innervation of the Heart 17
Transition from Fetus to Neonate 19
Conclusion 21
Chapter 2: Hemodynamic Monitoring 24
Cardiac Output 24
Introduction 24
Vascular Pressure Measurement 24
Measuring the Adequacy of Flow 32
Regional Perfusion 34
Assessing the Components of Cardiac Output 35
Chapter 3: Cardiopulmonary Interactions 44
Introduction 44
The Cardiopulmonary Circulation 44
The Effect of Changes in Intrathoracic Pressure on Heart Function 47
Cardiorespiratory Function and Heart Disease 52
Heart–Lung Interactions in Sepsis and Acute Respiratory Distress Syndrome 58
Conclusion 60
Chapter 4: Echocardiography in the Pediatric Critical Care Setting 66
Is There Systolic Dysfunction? 66
Introduction 66
Is There Pericardial Tamponade? 66
Is There Diastolic Dysfunction? 67
Does the Patient Have Pulmonary Hypertension? 68
What Is the Volume Status of the Patient? 69
Does the Patient Have a Significant Residual Postoperative Lesion? 69
Does the Patient Have Pulmonary Arteriovenous Malformations? 70
Does the Patient Have a Cardiac Contusion? 70
Does the Patient Have an Intracardiac Thrombus? 70
Are There Intracardiac Vegetations? 70
Conclusion 71
Chapter 5: Cardiac Catheterization in the Pediatric Critical Care Setting 73
Introduction 73
Indications 73
Practical Considerations 74
Sedation and Anesthesia 76
Vascular Access 77
Course of Catheterization 79
Angiography 79
Hemodynamic Determinations 81
Emergency Cardiac Catheterization 83
Complications 83
Cardiac Catheterization in Specific Circumstances 84
Applying Catheterization Principles at the Bedside 85
Summary of Hemodynamic Calculations 85
Chapter 6: Introduction to Congenital Heart Disease: Nomenclature and Classification 87
Introduction 87
Van Praagh’s Segmental Approach to the Classification of Congenital Heart Disease 87
An Alternative Approach to the Classification of Congenital Heart Disease 88
International Congenital Heart Surgery Nomenclature and Database 88
Chapter 7: Palliative Procedures 90
Historical Perspective 90
Indications for Palliation 90
Catheter-Based Palliative Procedures 91
Intraoperative Assessment of Palliative Procedures 92
Postprocedure Management 92
Chapter 8: Congenital Heart Disease: Left-to-Right Shunt Lesions 94
Introduction 94
Patent Ductus Arteriosus 94
Atrial Septal Defect 95
Ventricular Septal Defect 96
Atrioventricular Canal Defects 98
Aortopulmonary Window Defects 99
Chapter 9: Congenital Heart Disease: Cyanotic Lesions with Decreased Pulmonary Blood Flow 101
Introduction 101
Initial Evaluation and Stabilization of the Cyanotic Neonate 101
Common Postoperative Concerns 103
Tetralogy of Fallot 104
Pulmonary Valve Stenosis 107
Pulmonary Atresia with Intact Ventricular Septum 108
Ebstein’s Anomaly 109
Chapter 10: Congenital Heart Disease: Left Ventricular Outflow Tract Obstruction 114
Valvar Aortic Stenosis 114
Coarctation of the Aorta 116
Interrupted Aortic Arch 117
Supravalvar Aortic Stenosis 118
Subvalvar Aortic Stenosis 119
Chapter 11: Congenital Heart Disease: Cyanotic Lesions with Increased Pulmonary Blood Flow 122
Introduction 122
Transposition of the Great Arteries 123
Truncus Arteriosus 124
Total Anomalous Pulmonary Venous Connection 125
Single-Ventricle Anomalies with Unobstructed Pulmonary Blood Flow 126
Chapter 12: Single-Ventricle Lesions 128
Introduction 128
The Neonate with Single-Ventricle Physiology 128
A Rational Approach to Single-Ventricle Physiology in the Newborn 130
A Rational Approach to Single-Ventricle Physiology in the Older Infant and Child 132
Chapter 13: Vascular Rings and Associated Malformations 138
Embryology/Pathology 138
Historical Perspective and Surgical Milestones 138
Presentation and Clinical Evaluation 141
Surgical and Intensive Care Unit Management 143
Outcomes 147
Conclusion 147
Chapter 14: Cardiopulmonary Bypass 149
Historical Perspective 149
Components of the Cardiopulmonary Bypass Circuit 150
Conduct of Cardiopulmonary Bypass 152
The Inflammatory Response to Cardiopulmonary Bypass 156
Blood Flow Strategies: Circulatory Arrest and Regional Perfusion 157
Ultrafiltration: Conventional, Modified, and Zero Balance 157
Chapter 15: Pediatric Myocardial Protection 164
Special Features of the Neonatal Myocardium 164
Introduction 164
Effects of Cardiopulmonary Bypass on the Myocardium 165
Delivery Systems 166
Hypothermia and Cardioplegia 166
Additives and Compositions of Cardioplegia 167
Leukocyte Depletion 168
Terminal Reperfusion 168
Ischemic Preconditioning 168
Experimental Myocardial Protection 169
Myocardial Protection During Transplantation 170
Chapter 16: Postoperative Care of the Pediatric Cardiac Surgical Patient 174
Introduction 174
Preoperative Evaluation 174
Intraoperative Course 175
Basic Principles of Postoperative Care 177
Lesion-Specific Postoperative Care 182
Conclusion 184
Chapter 17: Mechanical Support of the Cardiovascular System: Extracorporeal Life Support/Extracorporeal Membrane Oxygenation and Ventricular Assist Devices 187
Introduction 187
Current Status of Extracorporeal Life Support/ Extracorporeal Membrane Oxygenation for Pediatric Cardiac Disease 187
Current Status of Ventricular Assist Devices for Pediatric Cardiac Disease 193
New and Emerging Devices for Pediatric Mechanical Circulatory Support 194
A Comparison of Extracorporeal Membrane Oxygenation Versus Ventricular Assist Device Support for Pediatric Cardiac Disease 195
Conclusion 196
Chapter 18: Mechanical Support of the Cardiovascular System: Intraaortic Balloon Pumping in Children 199
Background 199
Introduction 199
Patient Selection and Initiation and Maintenance of Intraaortic Balloon Pumping 200
Timing of Intraaortic Balloon Pumping in the Pediatric Population 201
Weaning 203
Diastolic Augmentation in the Compliant Pediatric Aorta 204
Results of Intraaortic Balloon Pumping in Children 205
Complications 205
Conclusion 205
Chapter 19: Arrhythmias 207
Interpretation of Electrocardiograms 207
Introduction 207
Basic Mechanisms of Cardiac Arrhythmias 210
Treatment of Bradyarrhythmia 214
Treatment of Tachyarrhythmia 216
Special Circumstances Involving Arrhythmia in the Pediatric Intensive Care Unit 217
Chapter 20: Inflammatory Diseases of the Heart and Pericardium: Infective Endocarditis and Kawasaki Disease 220
Infective Endocarditis 220
Kawasaki Disease 225
Chapter 21: Inflammatory Diseases of the Heart and Pericardium: Dilated Cardiomyopathy and Myocarditis 230
Dilated Cardiomyopathy 230
Myocarditis 235
Chapter 22: Diseases of the Pericardium 243
Introduction 243
Pericarditis 243
Cardiac Tamponade 244
Chapter 23: Management of Hypertension in the Pediatric Intensive Care Unit 250
Determinants of Blood Pressure 250
Introduction 250
Definitions 250
Blood Pressure Monitoring 255
Etiology and Pathogenesis 256
Management of Hypertension 257
Chapter 24: Heart Transplantation 263
The Pretransplantation Period 263
Introduction 263
The Surgical Procedure 267
The Post-Transplantation Period 267
Long-Term Management 275
Conclusion 279
Index 285