Negative pressure ventilation as haemodynamic rescue following surgery forcongenital heart disease

A low cardiac output state is an important cause of morbidity and mortality following repair of tetralogy of Fallot (ToF). This is often refractory to conventional measures. The cardiac output of these patients is highly depe ndent on diastolic pulmonary arterial flow which is enhanced during spontan eous respiration, but much reduced by intermittent positive pressure ventil ation (IPPV). We report the successful use of negative pressure ventilation (NPV) as haem odynamic therapy in three children with a low output secondary to restricti ve right ventricular (RV) physiology following ToF repair. NPV produced a s ignificant haemodynamic improvement, with increases in cardiac output of gr eater than 100 % in two of the children. By augmenting pulmonary blood flow , and hence cardiac output, NPV has a role as adjunctive haemodynamic thera py in patients with a low output secondary to diastolic RV dysfunction, in whom early extubation is not possible.