October 7, 2010

Morning Report

Complications of Cardiac Surgery

Morbidity and Mortality rates have decreasedBetter techniquesPrevention of infectionsBetter knowledge of complications

Three time periodsImmediate post-opShort-term post-opLong-term post-op

Cardiac Surgery

Immediate post-opIntubationAnesthetic agentsBlood lossFluid managementLength of time on bypass

Cardiac SurgeryImmediate post-op

RespiratoryIntubation

Vocal cord damageSecretions

Low cardiac outputTachycardia, decreased UOP, decreased BPFluid vs pump failure

ArrhythmiasAny surgery near the atriaTachycardiaBradycardia

Cardiac SurgeryImmediate post-op

HTNCoarctation or PDAManaged medically but usually short livedCoarctation

Postcoarctation syndromeo Abd pain, infarction of bowel

ChylothoraxCreamy fluid in chest tubes, high fat content,

negative cultureDamage to thoracic ductModify diet – low fat

Portagen for babiesMay reside on own or require chest tubes or surgery

Cardiac Surgery

Short-term post-op

Postpericardiotomy SyndromeFebrile illness7-10 post op dayPericardial and/or pleural reactionChildren>InfantsExtensive proceduresMost cases are mild

May only be found on post op echo as an effusion

Cardiac SurgeryShort-term post-op

Postpericardiotomy SyndromeSymptoms

Fever into second post-op weeko Or may return in 2nd or 3rd week

Anterior precordial chest paino Increases on deep inspirationo Increases when supine

Intermittent friction rub

Cardiac SurgeryShort-term post-op

Postpericardiotomy SyndromeLab findings

Increased WBCo Left shift

Increased ESRECG

Flattened or inverted T wavesEcho

Pericardial effustion

Cardiac SurgeryShort-term post-op

Postpericardiotomy SyndromeUsually self limitedPersistence of effusion is concerning

Tamponadeo Muffled heart sounds, pulsus paradoxus, JVD

Antiinflammatory agentso ASA or steroids

Cardiac SurgeryLong-term post-op

Infective Endocardits

Cardiac Surgery

Long-term post-opInfective

Endocardits

Cardiac SurgeryLong-term post-op

ArrhythmiaSick sinus syndrome

SyncopePVCs

Need further monitoring

CHFCondition not relievedInjury to a critical areaHigh cardiac burden before surgery

Cardiac SurgeryLong-term post-op

Valvular regurgitationEven with good initial

resultsMay need second

surgery

AortopathyProgressive dilation of

ascending aortaCoarctationsClose follow up