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Preoperative management of the neonate with critical aortic valvar stenosis*

Published online by Cambridge University Press:  29 December 2014

Jeremy T. Affolter  and
Nancy S. Ghanayem
Jeremy T. Affolter*
Affiliation:
Department of Pediatrics, Herma Heart Center, Divisions of Cardiology and Critical Care, Medical College of Wisconsin, Children’s Hospital of Wisconsin, Milwaukee, Wisconsin, United States of America
Nancy S. Ghanayem
Affiliation:
Department of Pediatrics, Herma Heart Center, Divisions of Cardiology and Critical Care, Medical College of Wisconsin, Children’s Hospital of Wisconsin, Milwaukee, Wisconsin, United States of America
*
Correspondence to: J. T Affolter, MD, Medical College of Wisconsin, Children’s Hospital of Wisconsin, 9000 West Wisconsin Avenue, Milwaukee, WI 53226, United States of America. Tel: +414 266 5841; Fax: 414-266-3563; E-mail: [email protected]
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Abstract

Neonatal critical aortic stenosis is a rare form of CHD that often presents with cardiogenic shock. Although surgical and cardiac catheterisation-based interventions have been successful in alleviating left ventricular outflow tract obstruction, it remains associated with high morbidity and mortality. Critical aortic stenosis results in elevated left ventricular wall stress, which ultimately increases myocardial oxygen consumption and disrupts coronary artery perfusion during diastole, leading to ventricular dysfunction and cardiogenic shock. Critical care management before definitive intervention should be tailored to optimising oxygen delivery and reducing metabolic consumption of the myocardium and peripheral organ systems. This can be accomplished with prostaglandin infusion to maintain system perfusion through patency of the arterial duct, inotropic support, mechanical ventilation, and central nervous system abrogation. Management should also include a multi-specialty medical team including paediatric cardiothoracic surgeons and paediatric cardiologists with expertise in cardiac catheterisation, imaging, and transplantation.

Keywords

Critical aortic stenosispaediatric critical careneonatecardiogenic shock
Type
Original Article
Information
Cardiology in the Young , Volume 24 , Issue 6: HeartWeek 2014 , December 2014 , pp. 1111 - 1116
Copyright
© Cambridge University Press 2014 

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Footnotes

*

Presented at All Children’s Hospital Johns Hopkins Medicine 14th International Symposium on Congenital Heart Disease, Saint Petersburg, Florida, 15–18 February 2014, Special Focus: Diseases of the Cardiac Valves from the Fetus to the Adult, Co-Sponsor: The American Association for Thoracic Surgery (AATS).

References

1.Mitchell, SC, Korones, SB, Berendes, HW. Congenital heart disease in 56,109 births incidence and natural history. Circulation 1971; 43: 323–332.CrossRefGoogle Scholar
2.Kitchiner, DJ, Jackson, M, Walsh, K, Peart, I, Arnold, R. Incidence and prognosis of congenital aortic valve stenosis in Liverpool (1960–1990). Br Heart J 1993; 69: 71–79.Google Scholar
3.Carabello, BA. Clinical practice. Aortic stenosis. N Engl J Med 2002; 346: 677–682.CrossRefGoogle ScholarPubMed
4.Hastreiter, AR, Oshima, M, Miller, RA, Lev, M, Paul, MH. Congenital aortic stenosis syndrome in infancy. Circulation 1963; 28: 1084–1095.Google Scholar
5.Lakier, JB, Lewis, AB, Heymann, MA, Stanger, P, Hoffman, JI, Rudolph, AM. Isolated aortic stenosis in the neonate. Natural history and hemodynamic considerations. Circulation 1974; 50: 801–808.Google Scholar
6.Lofland, GK, McCrindle, BW, Williams, WG, et al. Critical aortic stenosis in the neonate: a multi-institutional study of management, outcomes, and risk factors. J Thorac Cardiovasc Surg 2001; 121: 10–27.Google Scholar
7.Opie, LH. Heart Physiology, from Cell to Circulation. Lippincott Williams & Wilkins, Philadelphia, 2004.Google Scholar
8.Mahony, L. Development of Myocardial Structure and Function, from Moss and Adams’, 7th edn. Lippincott Williams & Wilkins, Philadelphia, 2008.Google Scholar
9.Ghanayem, NS, Wernovsky, G, Hoffman, GM. Near-infrared spectroscopy as a hemodynamic monitor in critical illness. Ped Crit Care Med 2011; 12: S27–S32.Google Scholar
10.Spach, MS, Serwer, GA, Anderson, PAW, Canent, RV, Levin, AR. Pulsatile aortopulmonary pressure-flow dynamics of patent ductus arteriosus in patients with various hemodynamic states. Circulation 1980; 61: 110–122.Google Scholar
11.Bass, JL, Berry, JM, Einzig, S. Flow in the aorta and patent ductus arteriosus in infants with aortic atresia or aortic stenosis: a pulsed Doppler ultrasound study. Circulation 1986; 74: 315–322.Google Scholar
12.Valverde, E, Pellicer, A, Madero, R, Elorza, D, Quero, J, Cabanas, F. Dopamine versus epinephrine for cardiovascular support in low birth weight infants: analysis of systemic effects and neonatal clinical outcomes. Pediatrics 2006; 117: e1213–e1222.Google Scholar
13.Barrington, KJ, Finer, NN, Chan, WK. A blind, randomized comparison of the circulatory effects of dopamine and epinephrine infusions in the newborn piglet during normoxia and hypoxia. Crit Care Med 1995; 23: 740–748.Google Scholar
14.Burwash, IG. Low-flow, low-gradient aortic stenosis: from evaluation to treatment. Curr Opin Cardiol 2007; 22: 84–91.Google Scholar
15.Rhodes, LA, Colan, SD, Perry, SB, Jonas, RA, Sanders, SP. Predictors of survival in neonates with critical aortic stenosis. Circulation 1991; 84: 2325–2335.Google Scholar