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”.
Keywords: Cardiopulmonary bypass, low cardiac output syndrome, cardiopulmonary interactions, adrenal axis, thyroid axis.
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