ABSTRACT
Pulmonary hypertension (PH) often complicates perioperative course following pediatric cardiac surgery, often presenting unique challenges to the attending cardiac anesthesiologist. Apart from difficult weaning from cardiopulmonary bypass, PH can often compound weaning from mechanical ventilation in this postoperative subset. From pathophysiological standpoint, the former can be attributed to concurrent detrimental cardiopulmonary consequences of PH as a multisystemic syndrome. Therefore, with an objective to address the affected systems, that is, cardiac and pulmonary simultaneously, we report combined use of inhaled milrinone (a pulmonary vasodilator) through high-frequency nasal cannula (oxygen reservoir and continuous positive airway pressure delivery device), purported to complement each other's mechanism of action in the management of PH, thereby hastening postoperative recovery. This article additionally presents a nuanced perspective on the advantages of combining the aforementioned therapies and hence proposing the same as a possible postoperative cardiopulmonary elixir.
ABSTRACT
The novel coronavirus (SARS-CoV-2) is suggested to increase the risk of morbidity and mortality in patients with underlying cardiac and pulmonary disorders. Reports of COVID-19-related multisystem inflammatory syndrome in children, past experiences with influenza virus and the respiratory syncytial virus, and British Congenital Cardiac Association recommendation on congenital heart disease warrant caution even in children. We present a case of a 2-year-old child with tetralogy of Fallot, who got admitted in the emergency with cyanotic spell and fever (suspected to be due to COVID-19), potentially compounding the challenge of managing cyanotic spell emergency. © The Authors, published by EDP Sciences, 2021.