Mechanical Support for Cardiac and Respiratory Failure in Pediatric Patients [antikvár]

Foreword It has now been more than 60 years since Robert Gross pioneered surgery for congenital heart disease by ligadon of the patent ductus arteriosus in 1938. Following the introducdon of cardiopulmonary bypass by Gibbon in 1954, however, advances in the surgical care of children with heart disease made relatively slow progress in comparison with the spectacular advances for adults with coronary artery and valve disease. The principal reason for the lag of decades in providing equal care for children was that engineering efforts were focused on heart-lung machines for adults. The deleterious effects of early cardiopulmonary bypass circuits were intolerable to the infant and small child. Barratt-Boyes and Castaneda employed circulatory arrest to minimize exposure of the child to the damaging effects of bypass and demonstrated that primary repair of even complex congenital heart problems could be accomplished if one could avoid the damage inflicted on small bodies and immature organ systems by machines designed for adults. The discovery of prostaglandin E| in the mid-1970s opened the field of congenital heart surgery even further, since now even the neonates with ductal-dependent life-threatening heart disease could undergo careful diagnosis and a planned operation. But the medical device industry, which by now was reaping massive profits from coronary artery surgery, required considerable goading to become interested in development of bypass circuits specifically meant for infants and neonates. The first neonatal oxygenator was not released for sale until the 1990s, more than 35 years after heart-lung machines were first developed for adults. The small size of the pediatric "market" simply did not appeal to those in search of corporate profit. And now the story is being repeated in the development of ventricular assist devices. Remarkable progress has been made over the last 10 years on ventricular devices for adults with failing ventricles. Several devices are currently available for adults as a bridge to transplantation and even for long-term implantation. But no U.S. company is presently interested in developing a specific pediatric ventricular assist device. Ill