Improving respiratory outcomes after pediatric cardiac surgery: New uses for nitric oxide.

BACKGROUND: This month's issue of Journal of Cardiac Surgery features a retrospective study on the effect of combining inhaled nitric oxide with high frequency oscillator ventilation to rescue infants who have failed conventional ventilation after congenital heart surgery. AIMS: This commentary aims to place that study within the context of available published literature on the topic. MATERIALS AND METHODS: The PubMed database was queried for all English-language entries between 1995 and 2021 with the terms nitric oxide, congenital heart disease, oscillator, and respiratory failure. The results were then assessed for relevance and impact by the author. RESULTS: From these results, 15 articles were selected for use in this review. The cost of prolonged mechanical ventilation is described. The use of nitric oxide has been used to improve outcomes in hypoxic respiratory failure. High-frequency oscillator ventilation has also been studied in pediatric patients with ARDS. To date, no studies have been published showing the benefit of combining these two modalities in pediatric cardiac surgical patients. DISCUSSION: The results of this month's study on nitric oxide and high frequency oscillator ventilation are placed in the context of current literature and suggestions for further study are presented. CONCLUSION: Pediatric patients with hypoxic respiratory failure following congenital heart surgery have a new treatment strategy that appears effective. Further studies to confirm this should be undertaken.

Scoliosis Correction with One Ventricle: A Multispecialty Approach.

BACKGROUND: Patients with single-ventricle congenital heart disease may present for scoliosis correction. These patients undergo a series of cardiac operations that create a novel circulation that has a significant impact on the management of their spinal surgery. CASE DESCRIPTION: A 21-year-old man with severe scoliosis presented for posterior T4-L3 spinal fusion. He was born with complex congenital heart disease that resulted in his having a single functioning ventricle. He underwent a series of operations culminating in a Fontan procedure to palliate his heart disease. Both the surgical procedure and the anesthetic plan were modified based on his abnormal physiology, which led to a successful correction with no complications. CONCLUSIONS: Patients who have undergone a Fontan procedure can successfully undergo a lengthy scoliosis correction, but it requires multidisciplinary planning.