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Eur J Cardiothorac Surg 2008;33:613-618 233 Galantowicz M, Cheatham JP, Phillips A, et al Hybrid approach for hypoplastic left heart syndrome: intermediate results after the learning curve Ann Thorac Surg 2008;85:2063-2070; discussion 2070-2071 234 Pizarro C, Murdison KA, Derby CD, Radtke W Stage II reconstruction after hybrid palliation for high-risk patients with a single ventricle Ann Thorac Surg 2008;85:1382-1388 235 Bacha EA, Daves S, Hardin J, et al Single-ventricle palliation for high-risk neonates: the emergence of an alternative hybrid stage I strategy J Thorac Cardiovasc Surg 2006;131:163-171.e2 e7 Abstract: The neonatal myocardium is less compliant than that of the older child, less tolerant of increases in afterload, and less responsive to increases in preload A predictable decrease in cardiac index typically occurs to 12 hours after separation from cardiopulmonary bypass, but milrinone administration during the early postoperative period may attenuate this phenomenon Patients with postoperative low cardiac output require careful evaluation for unanticipated residual lesions Patients with restrictive physiology from hypertrophy and diastolic dysfunction of the right ventricle may require high right-sided filling pressures to achieve adequate cardiac output, making them prone to hepatic congestion, anasarca, pleural effusions, and ascites Inhaled nitric oxide plays an important role in the management of postoperative pulmonary hypertension in the cardiac intensive care unit Hypoxemia after bidirectional cavopulmonary anastomosis generally is a sign of decreased pulmonary blood flow related to reduced cardiac output Liberation from positive-pressure mechanical ventilation should be accomplished as soon as feasible, particularly in patients after a cavopulmonary anastomosis (bidirectional Glenn) or Fontan operation because spontaneous breathing improves pulmonary blood flow, arterial oxygen saturation, and ventricular preload Ventricular ectopy and elevated atrial pressures after the arterial switch operation should raise suspicion of myocardial ischemia from insufficient coronary blood flow Postoperative care of the patient with hypoplastic left heart syndrome after stage I palliation (Norwood procedure) may require delicate balancing of the pulmonary and systemic blood flows A high arterial oxygen saturation denotes excessive pulmonary blood flow and in patients with impaired ventricular output is generally accompanied by inadequate systemic blood flow, acidosis, and end-organ dysfunction Key words: cavopulmonary shunt, hybrid procedure, Fontan procedure, Norwood procedure, interrupted aortic arch, coarctation of the aorta, hypoplastic left heart syndrome, transposition of the great arteries, single ventricle ... cavopulmonary connection Ann Thorac Surg 2012;93:1254-1260; discussion 1261 140 Booth KL, Roth SJ, Thiagarajan RR, Almodovar MC, del Nido PJ, Laussen PC Extracorporeal membrane oxygenation support... cardiopulmonary bypass, but milrinone administration during the early postoperative period may attenuate this phenomenon Patients with postoperative low cardiac output require careful evaluation for unanticipated... after a cavopulmonary anastomosis (bidirectional Glenn) or Fontan operation because spontaneous breathing improves pulmonary blood flow, arterial oxygen saturation, and ventricular preload Ventricular