Following surgery for congenital heart disease, patients develop a predictable and progressive
decline in cardiac output known as low cardiac output syndrome. During low cardiac output
states, a compensatory response to increase systemic perfusion occurs both innately and as part of the
postoperative pharmacologic support strategies intended to increase or sustain adequate oxygen delivery.
The result typically involves a rise in systemic vascular resistance and heart rate. These and other
responses may actually limit the ability of the recently operated heart to provide sufficient cardiac
output to meet the oxygen demands of the body. In order to improve systemic oxygen delivery, clinicians have increasingly
employed systemic vasodilator therapy to reduce afterload and improve ventriculoarterial coupling. This review will
summarize currently utilized pharmacologic agents that promote systemic vasodilation and improve cardiac output
through afterload reduction. This article addresses the fourth of eight topics comprising the special issue entitled “Pharmacologic
strategies with afterload reduction in low cardiac output syndrome after pediatric cardiac surgery”.
Keywords: Low cardiac output syndrome, afterload reduction, nitroprusside, nitroglycerin, nesiritide, phenoxybenzamine,
phentolamine, milrinone, levosimendan.
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