title: Pathophysiology of Post-Operative Low Cardiac Output Syndrome.
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".
authors.affiliation: Pediatrics 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.
authors.forename: Conrad L
authors.initials: CL
authors.lastname: Epting
authors.forename: Mary E
authors.initials: ME
authors.lastname: McBride
authors.forename: Eric L
authors.initials: EL
authors.lastname: Wald
authors.forename: John M
authors.initials: JM
authors.lastname: Costello
mesh_terms: D002302:Cardiac Output / Q000502:physiology; D002303:Cardiac Output, Low / Q000453:epidemiology / Q000209:etiology / Q000503:physiopathology*; D006348:Cardiac Surgical Procedures / Q000009:adverse effects*; D002315:Cardiopulmonary Bypass / Q000009:adverse effects; D002648:Child; D006801:Humans; D007223:Infant; D009206:Myocardium / Q000473:pathology; D011183:Postoperative Complications / Q000453:epidemiology / Q000503:physiopathology*