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Chapter 26 - Stage I Palliation, Hypoplastic Left Heart Syndrome

from Section 5 - Single-Ventricle Physiology

Published online by Cambridge University Press:  09 September 2021

By
Bishr Haydar
Edited by
Laura K. Berenstain  and
James P. Spaeth
Laura K. Berenstain
Affiliation:
Cincinnati Children's Hospital Medical Center
James P. Spaeth
Affiliation:
Cincinnati Children's Hospital Medical Center
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Summary

Noncardiac surgery in patients with hypoplastic left heart syndrome (HLHS) and other variants of single-ventricle physiology presents unique risks, especially prior to and after the first stage of surgical palliation. Although there are a number of cardiac defects that may be treated with single-ventricle palliation, there are principles that may be generalized for the perioperative care of these patients. Preoperative assessment of their status and knowledge of their pathophysiology may aid the anesthesiologist in mitigating these risks. Laparoscopy remains controversial in this population, as patients with single-ventricle physiology may be ill equipped to tolerate the physiologic derangements that laparoscopy induces. This chapter presents an overview of single-ventricle physiology including bedside clinical assessment, as well as the expected physiologic changes associated with laparoscopy. It then reviews the published outcomes of laparoscopic versus open Nissen fundoplication. Finally, it reviews specific and devastating perioperative complications that may occur in patients with stage I palliation.

Keywords

adverse eventscongenital heart defectcongenital heart diseasehypoplastic left heart syndromelaparoscopic fundoplicationmodified Blalock–Taussig shuntNissen operationnoncardiac surgeryNorwood procedure stage 1Sano shuntsingle-ventricle physiologythrive failure to
Type
Chapter
Information
Congenital Cardiac Anesthesia
A Case-based Approach
 , pp. 187 - 197
Publisher: Cambridge University Press
Print publication year: 2021

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References

References

Norwood, W. I., Lang, P., and Hansen, D. D.. Physiologic repair of aortic atresia-hypoplastic left heart syndrome. N Engl J Med 1983; 308: 23–6.CrossRefGoogle ScholarPubMed
Sano, S., Ishino, K., Kawada, M., et al. Right ventricle-pulmonary artery shunt in first-stage palliation of hypoplastic left heart syndrome. J Thorac Cardiovasc Surg 2003; 126: 504–9.Google Scholar
Pearl, J. M., Nelson, D. P., Schwartz, S. M., et al. First-stage palliation for hypoplastic left heart syndrome in the twenty-first century. Ann Thorac Surg 2002; 73: 331–39.CrossRefGoogle ScholarPubMed
Nicolson, S. C., Steven, J. M., Diaz, L. K., et al. Anesthesia for the patient with a single ventricle. In Andropoulos, D. B., Stayer, S., Mossad, E. B. et al., eds. Anesthesia for Congenital Heart Disease, 3rd ed. Hoboken, NJ: John Wiley & Sons, 2015; 567–97.Google Scholar
Sakka, S. G., Huettemann, E., Petrat, G., et al. Transesophageal echocardiographic assessment of haemodynamic changes during laparoscopic herniorrhaphy in small children. Br J Anaesth 2000; 84: 330–4.CrossRefGoogle ScholarPubMed
Gueugniaud, P. Y., Abisseror, M., Moussa, M., et al. The hemodynamic effects of pneumoperitoneum during laparoscopic surgery in healthy infants: assessment by continuous esophageal aortic blood flow echo-Doppler. Anesth Analg 1998; 86: 290–3.Google ScholarPubMed
Pennant, J. H.. Anesthesia for laparoscopy in the pediatric patient. Anesthesiol Clin North Am 2001; 19: 69–88.CrossRefGoogle ScholarPubMed
Wulkan, M. L. and Vasudevan, S. A.. Is end-tidal CO2 an accurate measure of arterial CO2 during laparoscopic procedures in children and neonates with cyanotic congenital heart disease? J Pediatr Surg 2001; 36: 1234–6.CrossRefGoogle ScholarPubMed
Kim, J., Sun, Z., Englum, B. R., et al. Laparoscopy is safe in infants and neonates with congenital heart disease: a national study of 3684 patients. J Laparoendosc Adv Surg Tech A 2016; 26: 836–9.Google Scholar
Slater, B., Rangel, S., Ramamoorthy, C., et al. Outcomes after laparoscopic surgery in neonates with hypoplastic left heart syndrome. J Pediatr Surg 2007; 42: 1118–21.CrossRefGoogle Scholar
Gulack, B. C. H. and Adibe, O. O.. Laparoscopic antireflux surgery in infants with single ventricle physiology: a review. J Laparoendosc Adv Surg Tech A 2013; 23: 733–7.Google Scholar
Chu, D. I., Tan, J. M., Mattei, P., et al. Mortality and morbidity after laparoscopic surgery in children with and without congenital heart disease. J Pediatr 2017; 185: 88–93.CrossRefGoogle ScholarPubMed
Gillory, L. A., Megison, M. L., Harmon, C. M., et al. Laparoscopic surgery in children with congenital heart disease. J Pediatr Surg 2012; 47: 1084–8.CrossRefGoogle ScholarPubMed
Garey, C. L., Laituri, C. A., Aguayo, P., et al. Outcomes in children with hypoplastic left heart syndrome undergoing open fundoplication. J Pediatr Surg 2011; 46: 859–62.CrossRefGoogle ScholarPubMed
Craig, B. T., Rellinger, E. J., Metter, B. A., et al. Laparoscopic Nissen fundoplication in infants with hypoplastic left heart syndrome. J Pediatr Surg 2016; 51: 76–80.Google Scholar
Gupta, A., Daggett, C., Drant, S., et al. Prospective randomized trial of ketorolac after congenital heart surgery. J Cardiothorac Vasc Anesth 2004; 18: 454–7.CrossRefGoogle ScholarPubMed

Suggested Reading

Chu, D. I., Tan, J. M., Mattei, P., et al. Outcomes of laparoscopic and open surgery in children with and without congenital heart disease. J Pediatr Surg 2018; 53: 1980–8.CrossRefGoogle ScholarPubMed
Nicolson, S. C., Steven, J. M., Diaz, L. K., et al. Anesthesia for the patient with a single ventricle. In Andropoulos, D. B., Stayer, S. A., Mossad, E. B., et al., eds. Anesthesia for Congenital Heart Disease, 3rd ed. Hoboken, NJ: John Wiley & Sons, 2015; 356–72.Google Scholar
Quintessenza, J., DeSena, H. C., Justice, L., et al. Hypoplastic left heart syndrome. In Ungerleider, R. M., Meliones, J. N., Nelson McMillan, K. et al., eds. Critical Heart Disease in Infants and Children, 3rd ed. Philadelphia: Mosby Elsevier, 2019; 778–95.Google Scholar
Short, J. A., Paris, S. T., Booker, P. D., et al. Arterial to end-tidal carbon dioxide tension difference in children with congenital heart disease. Br J Anaesth 2001; 86: 349–53.CrossRefGoogle ScholarPubMed
Watkins, S., Morrow, S. E., McNew, B. S., et al. Perioperative management of infants undergoing fundoplication and gastrostomy after stage I palliation of hypoplastic left heart syndrome. Pediatr Cardiol 2012; 33: 697–704.CrossRefGoogle Scholar

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