The purpose of this review is to discuss the management of the low cardiac output syndrome
(LCOS) following surgery for congenital heart disease. The LCOS is a well-recognized, frequent
post-operative complication with an accepted collection of hemodynamic and physiologic aberrations.
Approximately 25% of children experience a decrease in cardiac index of less than 2
L/min/m2 within 6-18 hours after cardiac surgery. Post-operative strategies that may be used to manage
patients as risk for or in a state of low cardiac output include the use of hemodynamic monitoring, enabling a timely
and accurate assessment of cardiovascular function and tissue oxygenation; optimization of ventricular loading conditions;
the judicious use of inotropic agents; an appreciation of and the utilization of positive pressure ventilation for circulatory
support; and, in some circumstances, mechanical circulatory support. All interventions and strategies should culminate in
improving the relationship between oxygen supply and demand, ensuring adequate tissue oxygenation.
Keywords: Acute kidney injury, heart failure, hemodynamic monitoring, low cardiac output, mechanical circulatory devices,
Pediatrics, vasoactive therapies.
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