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Pathophysiology of Post-Operative Low Cardiac Output Syndrome
Conrad L Epting1, Mary E McBride, Eric L Wald
1Pediatrics and Pathology, Lurie Children's Heart Center Biorepository, Ann & Robert H. Lurie Children's Hospital of Chicago, 225 East Chicago Ave. Box 73, USA. c-epting@northwestern.edu.
Insights
Low cardiac output syndrome (LCOS) after pediatric cardiac surgery is common. Understanding its causes, like myocardial depression and inflammation, is key to early recognition and intervention to reduce mortality.
Area of Science:
- Pediatric Cardiac Surgery
- Critical Care Medicine
- Cardiovascular Pathophysiology
Background:
- Low cardiac output syndrome (LCOS) is a frequent complication post-pediatric cardiac surgery.
- It typically manifests hours after cardiopulmonary bypass due to declining myocardial performance against increased demand.
- Unrecognized or untreated LCOS can lead to shock and increased mortality.
Purpose of the Study:
- To discuss the pathophysiology of LCOS in pediatric patients after cardiac surgery.
- To explore contributing factors including myocardial depression, altered loading conditions, and inflammation.
- To review neurohormonal, thyroid, and adrenal axis involvement.
Main Methods:
- Review of clinical experiences from four cardiac intensivists.
- Supported by primary sources and relevant reviews from PubMed searches.
- Inclusion of seminal textbooks in pediatric cardiac critical care.
Main Results:
- LCOS pathophysiology is multifactorial, involving myocardial depression post-bypass.
- Altered cardiac loading conditions and inflammation contribute to a hypermetabolic state.
- Dysregulation of neurohormonal, thyroid, and adrenal axes plays a role.
Conclusions:
- Early recognition and intervention are crucial for decreasing mortality in LCOS.
- Understanding the complex pathophysiology aids in developing effective management strategies.
- This review focuses on pharmacologic strategies and afterload reduction in pediatric LCOS.
Abstract:
Low cardiac output syndrome frequently complicates the post-operative care of infants and children following cardiac surgery. The onset of low cardiac output follows a predictable course in the hours following cardiopulmonary bypass, as myocardial performance declines in the face of an elevated demand for cardiac output. When demand outstrips supply, shock ensues, and early recognition and intervention can decrease mortality. Multifactorial in etiology, this article will discuss the pathophysiology of low cardiac output syndrome, including myocardial depression following bypass, altered cardiac loading conditions, and inflammation driving a hypermetabolic state. Contributions from altered neurohormonal, thyroid, and adrenal axes will also be discussed. Sources included the clinical experiences of four cardiac intensivists, supported throughout by primary sources and relevant reviews obtained through PubMed searches and from seminal textbooks in the field. This article addresses the second of eight topics comprising the special issue entitled "Pharmacologic strategies with afterload reduction in low cardiac output syndrome after pediatric cardiac surgery".
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