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Perioperative management of patients with poorly functioning ventricles in the setting of the functionally univentricular heart

Published online by Cambridge University Press:  10 January 2006

Joseph W. Rossano  and
Anthony C. Chang
Joseph W. Rossano
Affiliation:
Division of Pediatric Cardiology, Department of Pediatrics, Baylor College of Medicine and Texas Children's Hospital, Houston, Texas, United States of America
Anthony C. Chang
Affiliation:
Division of Pediatric Cardiology, Department of Pediatrics, Baylor College of Medicine and Texas Children's Hospital, Houston, Texas, United States of America
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Extract

The patient with a functionally univentricular heart is at increased risk for ventricular dysfunction for a variety of reasons. At birth, the pulmonary and systemic circulations are in parallel, leading to pulmonary overcirculation and a volume-loaded functional ventricle. Significant atrioventricular valvar regurgitation, abnormal ventriculoarterial coupling, diastolic dysfunction, and altered ventricular geometry can also contribute to long-term ventricular dysfunction. These collected circumstances place the patient at increased risk for perioperative morbidity and mortality. We will discuss in this review the pathophysiology that leads to ventricular dysfunction at each stage of surgical palliation, as well as the strategies for perioperative management. In addition, we will highlight novel strategies for management of ventricular dysfunction.

Keywords

Heart failureintensive careFontan circulationhypoplastic left heart syndrome

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