**8.1 Hemodynamic management**

Neonates may experience low-cardiac-output syndrome after surgical palliation for Ebstein's anomaly. Inotropic support and afterload reduction for support of right ventricular and left ventricular function are necessary. Reduction of right ventricular afterload by decreasing pulmonary vascular resistance protects right ventricular strain and reduces hemodynamically significant tricuspid valve regurgitation. Neonatal patients with Ebstein's anomaly who undergo single ventricular palliation may develop relative pulmonary hypertension or maintain elevated pulmonary vascular resistance and may benefit from inhaled nitric oxide and the use of muscle relaxants, in combination with pain control and sedation. In neonate surgical intervention, leaving an open sternum immediately after cardiopulmonary bypass facilitates ventilation at lower mean airway pressures and decreases right ventricular afterload. The sternum can be closed once improved myocardial function and a decrease in edema have been established.
