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Description
Table of Contents
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
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