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Page 4 of 6 Rao. Vessel Plus 2022;6:35 https://dx.doi.org/10.20517/2574-1209.2021.109

COVID-19. The authors concluded that prompt identification and appropriate treatment might lead to
satisfactory outcomes.

[9]
In the next paper, Drs. Saxena and Relan from All India Institute of Medical Sciences, New Delhi, India,
reviewed issues related to pregnancy with CHD. Following the introduction of the subject, the authors
described hemodynamic changes that occur during pregnancy as well as those that take place during
delivery and the postpartum period. They indicated that the physiological changes that occur during
pregnancy are additive to the already existing hemodynamic burden associated with CHD. They suggested
that all women with CHD should be assessed for their risk of pregnancy and counseled prior to becoming
pregnant; these should include risks both to the mother and fetus. They recommended using the modified
World Health Organization’s scoring system, the Cardiac Disease in Pregnancy (CARPREG) scores, for this
assessment. They listed these scoring systems in nicely organized tables. This is followed by a discussion of
the diagnosis and management of CHD during pregnancy. Discussion of management, including timing
and mode of delivery, peripartum care, and surgical and transcatheter interventions for CHD during
pregnancy. Then, they presented a review of the management of common complications seen in women
with CHD, including heart failure, arrhythmias, bleeding/thrombosis (anticoagulation), and infective
endocarditis. They addressed the management of specific CHDs, including Eisenmenger syndrome, CHD
associated with pulmonary stenosis, left ventricular outflow tract obstruction, coarctation of aorta, residua
following Fontan surgery, surgically repaired transposition of great arteries, and other congenital heart
diseases. They concluded that advances in existing practices to assess and manage women with CHD might
result in considerable improvement of outcomes both for the mother and fetus.

In the paper that follows, Drs. Sahulee and McKinstry from NYU Grossman School of Medicine, New
[10]
York, NY, reviewed pharmacological management of low cardiac output syndrome (LCOS) after cardiac
surgery in children. After defining the LCOS following cardiac surgery under cardiopulmonary bypass, the
authors described its prevalence, pathophysiology, and available therapeutic options. Optimization of
preload, maintenance of atrio-ventricular synchrony, methods to decrease afterload, and administration of
pharmacologic agents to augment cardiac output are among the major therapeutic approaches to achieve a
balance between tissue oxygen delivery and demand. Then, they presented a discussion of
catecholaminergic inotropes (epinephrine, dopamine, and dobutamine), inodilators (milrinone and
levosimendan), systemic vasodilators (sodium nitroprusside, nitroglycerine, nicardipine, nesiritide,
phenoxybenzamine), and pulmonary vasodilators (inhaled nitric oxide, iloprost, citrulline) along with their
relative merits in treating LCOS. Then, they reviewed adjunctive therapies using corticosteroids, thyroxine,
vasopressin, and norepinephrine in the management of LOCS. Finally, they suggested that extracorporeal
membrane oxygenation for patients who are refractory to medical management is detailed in the preceding
sections. They concluded that there is no a single pharmacologic agent that is useful in all patients to treat or
prevent LCOS, that milrinone, epinephrine, and dopamine are the most frequently used pharmacologic
agents at the present time, and meticulous multicenter clinical trials are required to determine the best
option to manage LCOS.

In the final paper, Drs. Wang-Giuffre and Doshi , also from our institution, discussed Cardiopulmonary
[11]
Exercise Test (CPET) prognostic measures following Fontan operation. The authors initially reviewed the
physiology of exercise in patients with Fontan circulation, stressing the importance of factors such as
preload dependency, ventricular compliance, atrio-ventricular valve regurgitation, chronotropic
competence, arrhythmias, peripheral vascular dysfunction, and abnormal ventilatory function. Then, they
discussed cardiopulmonary exercise measures, namely, VO2 peak (oxygen consumption at peak of
exercise), submaximal measures (VO2 at anaerobic threshold, O uptake efficiency slope, and exercise
2