Early Complications after Paediatric Cardiac Surgery

Nearly one quarter of all patients who undergo congenital heart surgery experience postoperative complications.¹ 

Consider:

• problems in children differ from adult heart disease
• primary underlying lesion
• preoperative condition and associated lesions
  • preoperative difficulties
• procedure performed
  • closed vs open heart
  • corrective vs palliative

Complication Profile

• Heart failure (new)
• Cyanosis
  • Increased
  • Unexpected persisting
• Residual lesions
  • ? importance
• Infection
  • Wound
  • Endocarditis
  • Urinary Tract
  • Intercurrent I Hospital acquired
• Effusion
  • Pericardial
  • Pleural
• Neurological Complications
  • Late seizures
  • Consequences of surgery
• Arrhythmia
• Complications of medications
  • ACE Inhibitor
  • Diuretics

Symptoms of suspicion:

• New adverse symptoms
• Unexpected persistence of previous symptoms
• Tachypnoea
• Poor feeding
• Fever
• Altered Consciousness / behaviour
• Nausea / vomiting

Actions

1. Differential should include cardiac causes (but not exclusively)
2. Avoid antibiotics without clear focus
3. Possible Investigations: urine / blood culture, CXR
4. Liaise with patient’s paediatric cardiologist
   (echocardiogram in children is not an “order test only”)

Reference:

1. Gamal AH, Ahmed EMK, Ahmed IE, Omar SA. Postoperative complications in pediatric cardiac surgery patients done in a tertiary hospital. J Curr Med Res Pract 2020;5:121-5. Available from: http://www.jcmrp.eg.net/text.asp?2020/5/2/121/284388.
2. Sholler, Gary. The Children’s Hospital at Westmead.