Andersons pediatric cardiology 376
Bạn đang xem bản rút gọn của tài liệu. Xem và tải ngay bản đầy đủ của tài liệu tại đây (129.36 KB, 3 trang )
mayprovetobeasaferanticoagulationstrategy.436,437
FIG.16.15 AchildwithaBerlinVentricularAssistDevice.Thechildis
extubated,deintensified,andfullyambulatory.
Newergenerationcontinuousflowassistdevicesdesignedforadultsare
increasinglybeingusedinchildren.TheseincludetheHeartmateII(Thoratec)
andHeartWareHVAD(HeartWare).438,439TheHVADdeviceinparticular,an
implantablepump,hasbeenusedinpatientswithbodysurfaceareasaslowas
0.6m2.439Bothofthesedeviceshavebeenusedtosupportpatientswith
biventricularaswellassingleventriclephysiology.440,441Unliketheother
devicesdescribedabove,withthetotalartificialheart(SynCardia),thepatient's
nativeventriclesareremovedandreplacedwithintracorporealpneumatic
pumpingchambers.Inadditiontotheoriginal70-mLdevice,asmaller,50-mL
devicehasrecentlybegunclinicalstudiesandhasincreasedthepotentialforuse
inthepediatricpopulation.Thetotalartificialheartmaybesuitableforsupport
ofpreviouslytransplantedpatientswithend-stagecomplicationssuchas
advancedcoronarydiseaseorrejectionasimmunosuppressivemedicationscan
beminimized.442,443Thetotalartificialheartmayalsobeuniquelysuitedfor
supportofthefailingFontancirculation.444Complex,extensive,andlengthy
reconstructioncanbeaccomplishedcombinedwithimplantationofatotal
artificialhearttoallowforrehabilitationandapotentiallymorestraightforward
hearttransplantwithfeweranatomicchallenges.
Conclusions
Thebeginningofcardiacsurgerycanbetracedtotheligationofthepersistently
patentarterialduct,performedbyRobertGrossin1938,andreportedin1939.
Cardiacsurgerybegan,therefore,withthetreatmentofcongenitalcardiac
disease.Inthelast80years,wehaveseentremendousprogress.Correctionor
palliationofcongenitallymalformedheartsisnowroutinelyperformedininfants
andneonates,withtheexpectationofsurvivalinmostinstances.Ourgoalinthis
chapterhasbeentoreviewissuescommontoallcongenitalcardiacoperations
includingincisions,materialsused,conductofCPB,andtheoptionsfor
extracorporealsupport.Wehavesoughttoprovideabalancedoverviewofthe
currentstateoftheart,includingthemeanandfirststandarddeviationof
thought.Thetopicofsurgicaltechniquesisvast,andobviouslybeyondthescope
ofasinglechapter.Webelievewehaveprovidedabackground,context,anda
reasonablestartingpointformorethoroughinvestigation.
