The pediatric myocardium is unique in its response to, and tolerance of, the stresses of heart surgery. While generally being more tolerant of ischemia than the adult heart, there are important aspects of the immature myocardium that put it at risk. This relates to intrinsic features of the immature myocardium, as well as the anatomic and pathophysiologic characteristics of congenital heart defects, which can place pressure and/or volume loads on the heart. While some of the strategies of myocardial protection are common between adults and children, many important features of pediatric myocardial protection are unique. These relate to the use of hypothermia, types of cardioplegia, and strategies to vent the child’s heart. Adequate myocardial protection is critical for optimizing myocardial function following surgery. This is especially true in pediatric cardiac surgery, where palliative and reparative surgeries place unique stresses on the heart and sometimes require longer arrest times to effect complete intracardiac repair, ideal palliation, or biventricular conversion. This chapter will address the features of the immature, developing myocardium that impact its tolerance of ischemia, myocardial function and recovery following heart surgery, and the intra-operative techniques used to optimize myocardial protection.
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