Practical use of alpha blockade strategy in the management of hypoplastic left heart syndrome following stage one palliation with a Blalock-Taussig shunt.
Alpha blockade with phenoxybenzamine has been used in the postoperative management after the Norwood operation. The principle of this approach is the increase in systemic cardiac output by maximal dilation of the systemic circulation. This effect results in a more stable parallel circulation through prevention of fluctuations in systemic vascular resistance in the early postoperative period. We have incorporated this approach in our postoperative management protocol and have observed a decrease in sudden cardiac collapse. This article describes the practical use of alpha blockade strategy, its clinical application, and the most common clinical scenarios observed during the initial hours following stage one palliation with a Blalock-Taussig shunt for hypoplastic left heart syndrome in our cardiac surgery unit.
Division of Cardiovascular Surgery, The Hospital for Sick Children, Ontario, Canada.
Nilto C
NC
De Oliveira
Glen S
GS
Van Arsdell
D000317:Adrenergic alpha-Antagonists / Q000494:pharmacology / Q000627:therapeutic use*; D000465:Algorithms; D002302:Cardiac Output / Q000187:drug effects*; D006348:Cardiac Surgical Procedures / Q000379:methods; D006801:Humans; D018636:Hypoplastic Left Heart Syndrome / Q000188:drug therapy* / Q000601:surgery; D007231:Infant, Newborn; D010166:Palliative Care; D010643:Phenoxybenzamine / Q000494:pharmacology / Q000627:therapeutic use*; D016896:Treatment Outcome; D014662:Vasoconstrictor Agents / Q000627:therapeutic use; D014667:Vasopressins / Q000627:therapeutic use
D000317:Adrenergic alpha-Antagonists; D014662:Vasoconstrictor Agents; D010643:Phenoxybenzamine; D014667:Vasopressins