Michela Palma, Giancarlo Scognamiglio^*, Flavia Fusco, Assunta Merola, Anna Correra, Diego Colonna, Emanuele Romeo, Berardo Sarubbi

Congenital Heart Disease, Vol.15, No.1, pp. 33-49, 2020, DOI:10.32604/CHD.2020.011523

Abstract Adults with congenital heart disease (ACHD) constitute a growing population with complex cardiac physiopathology and frequent extra-cardiac involvement. The recent dramatic improvement of their life expectancy has resulted in an increasing proportion of ACHD patients requiring non-cardiac surgery. While a large body of evidence demonstrated the importance of an accurate risk assessment in patients with acquired heart disease before noncardiac surgery in order to reduce perioperative morbidity and mortality and detailed algorithms have been released by international societies, no specific guidelines are available for the perioperative management in this population. Nonetheless, understanding the complex anatomy and unusual physiology of both… More >

Regan E. Giesinger¹, Adrianne R. Bischoff³, Patrick J. McNamara^1,2

Congenital Heart Disease, Vol.14, No.2, pp. 311-316, 2019, DOI:10.1111/chd.12738

Abstract Ligation of a hemodynamically significant ductus arteriosus results in significant changes in loading conditions which have predictable consequences. Postligation cardiac syndrome, defined as hypotension requiring inotropic support and failure of oxygenation and ventilation, may occur 6‐12 hours following ligation due to left ven‐ tricular systolic and diastolic failure, respectively. Afterload is the primary driver of this decompensation. In this review, we describe the pathophysiological changes in loading conditions associated with postligation cardiac syndrome and other contrib‐ utors to cardiovascular dysfunction following ductal ligation. We present strategies for perioperative optimization and a physiology‐based algorithm for postoperative management guided by targeted neonatal… More >