By Richard A. Jonas
This booklet is the 1st unmarried authored textbook protecting the full spectrum of surgical administration of congenital middle illness. the writer, Dr. Richard Jonas, is the manager of Cardiovascular surgical procedure at Children's sanatorium Boston and the fourth William E Ladd Professor of surgical procedure at Harvard scientific tuition. administration of congenital middle ailment this day calls for a collaborative attempt via a wide healthcare staff together with congenital cardiac surgeons but in addition pediatric cardiologists, pediatric cardiac intensivists, pediatric cardiac anesthesiologists, perfusion and respiration technicians and pediatric nurses. All of those contributors have to have a transparent knowing of the surgical manipulations that occur within the working room. This textbook presents fantastically illustrations that essentially depict even the main complicated techniques. yet this booklet is way greater than an operative atlas. It provides evidence-based drugs that gives various medical citations which clarify not just how an operation may be performed but additionally while and why it may be performed and the results of those interventions.
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Extra info for Comprehensive Surgical Management of Congenital Heart Disease (Hodder Arnold Publication)
A helpful technique to control bleeding is to draw tissue over the needle holes with ﬁne prolene horizontal mattress sutures. 13). The bites in the PTFE should be partial thickness. of bank blood in relatively large quantities which can begin the vicious cycle of bleeding and transfusion. Packing Excessive hemodilution Hemodilution dilutes not only red cells but also coagulation factors. The surgeon who complains that the blood is like water often has him or herself to blame. Aiming for a perfusate hematocrit of 30% is almost certainly preferable to a lower hematocrit not only for its greater oxygen carrying capacity but also because it means less dilution of coagulation factors and platelets.
Shunt thrombosis after a Norwood operation is a life-threatening event as is coronary thrombosis after an arterial switch. On the other hand an experienced surgical team can almost always manage bleeding without too much difﬁculty. We do not use aprotinin for the arterial switch but we do recommend it for most other neonatal procedures, such as truncus repair and interrupted aortic arch. Antiﬁbrinolytic agents Epsilon amino caproic acid (Amicar) and tranexamic acid are useful agents which are not quite as effective as aprotinin in controlling post-pump bleeding.
At the same time the cardioplegia site in the ascending aorta is widely opened to allow air to vent. Blood can be used to ﬁll the left heart if a single venous cannula is in use. By raising the venous pressure by temporarily retarding venous return, blood will pass through the lungs into the left heart where it will displace air as long as there is an open vent site, such as the cardioplegia needle site in the ascending aorta. Blood can also be delivered into the left heart by inﬂation of the lungs though one must be careful to prevent the subsequent negative pressure created as the lungs relax drawing air back into the left heart.