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Providing Mechanical Support to Children Size and Anatomical Considerations 

Providing Mechanical Support to Children Size and Anatomical Considerations
Chapter:
Providing Mechanical Support to Children Size and Anatomical Considerations
Author(s):

Kyle W. Riggs

and David L. S. Morales

DOI:
10.1093/med/9780190909291.003.0030
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date: 29 May 2020

Mechanical circulatory support (MCS) in children has changed greatly during the past two decades. Historically, extracorporeal membranous oxygenation was the only mechanical support option for children. The introduction and widespread use of the Berlin Heart EXCOR pump—a pulsatile, pneumatic compression device still commonly used in small children—allowed the use of ventricular assist devices (VAD). This chapter describes the leading MCS options in small children with complex pathology and reviews the evolution of cannulation strategies for long-term support. It describes an advanced imaging technique that allows devices to be “virtually fit” to patients before implantation, a technology that may increase the number of eligible patients receiving devices thought to be too large by body surface area alone. Although body imaging is required, virtual fit will supplant the antiquated use of weight and body surface area in planning complicated implantations. Finally, the chapter presents MCS management strategies for different congenital anomalies, such as single-ventricle pathology and arterial transpositions.

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