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Cyanotic CHD Lesions with Decreased Pulmonary Blood Flow

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Pediatric Critical Care Medicine

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Abstract

Infants with congenital heart defects associated with cyanosis and decreased pulmonary blood flow are a heterogenous group of patients. The complex aspects of the provision of intensive care for this patient population are largely concentrated in the newborn period, which is the focus of this chapter. An approach to the initial evaluation and stabilization of the cyanotic neonate with suspected congenital heart disease is provided. The anatomy, pathophysiology and clinical presentation, preoperative evaluation, surgical or transcatheter intervention, and postoperative care and outcome for tetralogy of Fallot with pulmonary stenosis are discussed. The concept of restrictive right ventricular physiology is covered in detail. The salient features of complex variants of tetralogy of Fallot are also noted, including pulmonary atresia, absent pulmonary valve syndrome and atrioventricular canal defect. A similar approach is used to discuss patients with pulmonary valve stenosis, pulmonary atresia with intact ventricular septum, and Ebstein’s anomaly of the tricuspid valve. With each lesion, esoteric nuances related to the physiology and perioperative care are noted that may contribute to improved outcomes for this complex group of patients.

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Authors and Affiliations

  1. Division of Cardiology, Ann & Robert H. Lurie Children’s Hospital of Chicago, 225 E. Chicago Avenue, 21, Chicago, 60611-2605, IL, USA

    John M. Costello MD, MPH

  2. Department of Critical Care Medicine, The Hospital for Sick Children, 555 University Avenue, Toronto, M56 1X8, Onterio, Canada

    Peter C. Laussen MBBS

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  1. John M. Costello MD, MPH
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  2. Peter C. Laussen MBBS
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Correspondence to John M. Costello MD, MPH .

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Editors and Affiliations

  1. Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA

    Derek S. Wheeler

  2. Div. of Critical Care Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA

    Hector R. Wong

  3. Pediatric Critical Care Medicine, University of Michigan Medical School, Ann Arbor, Michigan, USA

    Thomas P. Shanley

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Costello, J.M., Laussen, P.C. (2014). Cyanotic CHD Lesions with Decreased Pulmonary Blood Flow. In: Wheeler, D., Wong, H., Shanley, T. (eds) Pediatric Critical Care Medicine. Springer, London. https://doi.org/10.1007/978-1-4471-6356-5_21

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  • DOI: https://doi.org/10.1007/978-1-4471-6356-5_21

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