Multiprofessional Critical Care Review: Pediatric 2024 (MCCRCP24ON)-Congenital Cardiac Malformations

Congenital Cardiac Malformations

Pdf Summary

This document provides an overview and details on congenital cardiac malformations and post-operative care for pediatric patients undergoing cardiac surgery. Authored by Ravi R. Thiagarajan from Boston Children’s Hospital and Harvard Medical School, the document delves into the incidence, diagnosis, and management of congenital heart disease (CHD).<br /><br />**Key Highlights:**<br /><br />**Incidence and Diagnosis:**<br />- CHD affects 4-10 per 1000 live births, with one-third requiring hospitalization in infancy. It often coexists with other anomalies and genetic syndromes such as DiGeorge Syndrome.<br />- Diagnosis can be prenatal using echocardiography, and also via cardiac catheterization and imaging techniques like CT and MRI.<br /><br />**Cardiac Catheterization:**<br />- This technique is vital for assessing cardiac output and shunt through calculations involving the Fick equation, resistances like SVR and PVR, and oxygen content.<br /><br />**Significant Conditions Detailed:**<br />- **Tetralogy of Fallot:** Characterized by ventricular septal defect (VSD), right ventricular outflow tract obstruction (RVOTO), and right ventricular hypertrophy (RVH). Management includes comfort measures and medications to increase systemic vascular resistance.<br />- **Single Ventricle CHD & Hypoplastic Left Heart Syndrome (HLHS):** These conditions require maintaining a balance between systemic and pulmonary vascular resistance for adequate cardiac output. HLHS needs surgical stages for palliation including the Norwood operation, Glenn procedure, and Fontan operation.<br /><br />**Post-Operative Care:**<br />- Emphasizes maintaining cardiac output and tissue oxygen delivery with medications like epinephrine and mechanical support like ventilation.<br />- Post-Fontan physiology management includes ensuring adequate preload, early extubation, appropriate ventilation strategies, and maintaining sinus rhythm.<br /><br />**Temporary Cardiac Pacing:**<br />- Describes the use of temporary pacing wires and pacemaker settings to manage post-operative patients with pacing codes and modes like AAI, VOO, and DDD.<br /><br />**Conclusion:**<br />The summary emphasizes the critical understanding of the circulation, physiology, and meticulous management needed post-cardiac surgery in children with CHD, highlighting the importance of maintaining cardiac output and addressing residual lesions.

Keywords

congenital cardiac malformations

pediatric cardiac surgery

congenital heart disease

CHD diagnosis

Tetralogy of Fallot

Hypoplastic Left Heart Syndrome

post-operative care

cardiac catheterization

temporary cardiac pacing

Ravi R. Thiagarajan

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