日本小児循環器学会雑誌 Pediatric Cardiology and Cardiac Surgery

From a physiologic perspective, children are equal to adults. In congestive heart failure, elevated left end-diastolic pressure causes pulmonary venous congestion, and leads to capillary leakage into the alveoli. In this situation, diuretics and positive airway pressure are useful in both adults and children; however, pediatricians should also consider children’s characteristics. For example, a child’s airway is small, which has an impact on airway resistance, particularly when it is swollen. Dead space is another key factor that needs to be considered. Furthermore, in many congenital heart diseases, pulmonary blood flow is not equal to systemic blood flow. Thus, pediatric cardiologists must consider the relationship between pulmonary blood flow and the airway, and the impact of oxygen therapy on pulmonary blood flow. Moreover, it is important to determine specific reactions in congenital heart diseases. For example, in normal circulation, positive intrathoracic pressure assists the left ventricle myocardium; however, in Fontan patients, positive intrathoracic pressure decrease cardiac output. Therefore, pediatric cardiologists must be familiar with cardiovascular physiology and respiratory physiology, and their interaction (i.e., the cardiopulmonary interaction).