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Manipulating parallel circuits: the perioperative management of patients with complex congenital cardiac disease

Published online by Cambridge University Press:  24 May 2005

John Lawrenson
Affiliation:
Departments of Paediatric Cardiology and Intensive Care, Gasthuisberg University Hospital, Catholic University of Leuven, Belgium Current address – Paediatric Cardiology Unit, Red Cross Children's Hospital, University of Cape Town, Cape Town, South Africa
Benedicte Eyskens
Affiliation:
Departments of Paediatric Cardiology and Intensive Care, Gasthuisberg University Hospital, Catholic University of Leuven, Belgium
Dirk Vlasselaers
Affiliation:
Departments of Paediatric Cardiology and Intensive Care, Gasthuisberg University Hospital, Catholic University of Leuven, Belgium
Marc Gewillig
Affiliation:
Departments of Paediatric Cardiology and Intensive Care, Gasthuisberg University Hospital, Catholic University of Leuven, Belgium

Abstract

In all patients undergoing cardiac surgery, the effective delivery of oxygen to the tissues is of paramount importance. In the patient with relatively normal cardiac structures, the pulmonary and systemic circulations are relatively independent of each other. In the patient with a functional single ventricle, the pulmonary and systemic circulations are dependent on the same pump. As a consequence of this interdependency, the haemodynamic changes following complex palliative procedures, such as the Norwood operation, can be difficult to understand.

Comparison of the newly created surgical connections to a simple set of direct current electrical circuits may help the practitioner to successfully care for the patient. In patients undergoing complex palliations, the pulmonary and systemic circulations can be compared to two circuits in parallel. Manipulations of variables, such as resistance or flow, in one circuit, can profoundly affect the performance of the other circuit. A large pulmonary flow might result in a large increase in the saturation of haemoglobin with oxygen returning to the heart via the pulmonary veins at the expense of a decreased systemic flow. Accurate balancing of these parallel circulations requires an appreciation of all interventions that can affect individual components of both circulations.

Type
Review
Copyright
© 2003 Cambridge University Press

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References

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