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1、SequelaeofCongenitalHeartDiseaseintheAdultPaulReynolds,MDUmaandSujitPanditProfessorandChiefofPediatricAnesthesiologyTheUniversityofMichiganDepartmentofAnesthesiologyTopicstobeDiscussedIncidenceHistoryPrimeronCHDSpecificheartdefectsPregnancyCongenitalHeartDiseas
2、eOccursin1/100livebirths40,000births/yearintheUSAaloneOfchildrenhavingsurgery:50%<1yearold25%<1monthold1/13infantdeathsduetoCHDCongenitalHeartDisease30%ofcongenitaldiseaseiscardiacCHDmortalitydecreased40%inpast20years80%ormoresurvivetoadulthood2millionadultswit
3、hCHDintheUStoday50%wouldhavediedwithoutintervention10%ofallCHDarefirstdiagnosedinadulthood2XasmanychildrendieofCHDasallcancercombinedFundingforchildhoodcancer5XhigherthanCHD.SurgicalMortalityAccordingToAgeAndYearsIncidenceVSD30%PDA9%ASD7%CoA6%TGA5%TOF5%PS7%AS5%
4、HLHS<1%Other25%ProceedingsoftheNationalHeart,LungandBloodinstitutePediatricCardiologyWorkshop,Pulmonaryhypertension,pediatricresearch,vol20(1986),pp811-824.HistoryofCardiacSurgery1938-1948:closedheartsurgery1952-1955:openheartsurgeryforCHD1960-1970:openheartsur
5、geryforacquireddisease1970-1980:improvedCPB,coldcardioplegia,DHCA1980-1990:transplantation,neonatalsurgery,IMAs,aprotinin1990-1999:fasttracking,minimallyinvasivesurgery,offbypassCABG,NO,3stageHLHrepair2000-present:VAD,TransmyocardialLaserRevascularization,hybri
6、dprocedures,Melodyvalves,TAVRQp/QsNormal=1<1=RtoLshunt“Blue”>1=LtoRshunt“Pink”ShuntPhysiologyinCHDToomuchpulmonarybloodflowleadstocongestiveheartfailureandeventuallypulmonaryvasculardiseaseToolittlepulmonarybloodflowleadstocyanosisandsystemichypoxemiaPulmonaryV
7、ascularResistanceIncreasedby:Decreasedby:hypoxiaoxygenhypercarbiahyperventilationacidosisalkalosisalphaagonistsalphaantagonistsatelectasisPGE/prostaglandinshypovolemiavasodilators(SNP,NO)hypothermiaamrinone/milrinonehighairwaypressures(PEEP)isoproterenolBloodfl
8、owthroughShuntsPoiseuille'sLaw:Resistancealength/radius4Sizeoforifice(orlengthofshunt)PressureinthechambersoneithersideofshuntResistancesdownstream(PVRandSVR)RighttoLeftShun
