Heart Disease in Children Handbook: A Lesion-Based Approach to Congenital Defects, Hemodynamic Physiology, and Perioperative Management for PICU Clinicians

Built for clinicians who manage children with congenital and acquired heart disease in the ICU, this handbook connects segmental anatomy, hemodynamics, imaging, catheter data, rhythm interpretation, perioperative physiology, and mechanical support to the decisions made at the bedside. It moves from morphogenesis and lesion classification through shunts, obstructive lesions, cyanotic physiology, coronary risk, single-ventricle palliation, perioperative care, arrest prevention, ECMO/VAD escalation, transplant, and adult congenital transition. The organizing frame is practical: identify the lesion, define the physiology, recognize the failing pathway, and act before oxygen delivery collapses. The included Lesion-to-Bedside Decision Atlas gives readers a structured reference navigator for ductal-dependent flow, pulmonary venous obstruction, residual lesions, arrhythmia, pulmonary hypertensive crisis, low cardiac output, tamponade, and mechanical-support escalation. • Decode segmental anatomy and lesion classification — translate situs, looping, venous return, AV connections, and ventriculoarterial relationships into ICU-relevant physiology. • Manage shunts and obstructive lesions — separate pulmonary overcirculation, systemic steal, ductal dependence, valve disease, and postoperative residual obstruction. • Interpret cyanosis and mixing physiology — recognize restricted pulmonary blood flow, inadequate mixing, parallel circulation, conotruncal lesions, and coronary-risk states. • Navigate single-ventricle care — follow Norwood, Glenn, Fontan, shunt, Sano, and interstage physiology through deterioration and recovery. • Use imaging, cath data, ECG, and waveforms — connect echo, TEE, CT, MRI, oximetry, pressure tracings, rhythm strips, and bedside monitors to action. • Escalate perioperative instability — identify low cardiac output, pulmonary hypertensive crisis, tamponade, bleeding, thrombosis, arrest risk, ECMO, ECPR, and VAD candidacy. • Extend care beyond the ICU moment — integrate genetics, trauma, transplant, nutrition, recovery, transition planning, outcomes, and team-based quality improvement. Use it as a lesion-based clinical reference for sharper decisions in the care of children with heart disease.