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
