Faculty Collaboration Database

Preoperative management of the neonate with critical aortic valvar stenosis. Cardiol Young 2014 Dec;24(6):1111-6

Date

02/04/2015

Pubmed ID

25647388

DOI

10.1017/S1047951114002029

Scopus ID

2-s2.0-84927630825 (requires institutional sign-in at Scopus site)   9 Citations

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.

Author List

Affolter JT, Ghanayem NS

MESH terms used to index this publication - Major topics in bold

Alprostadil
Aortic Valve Stenosis
Balloon Valvuloplasty
Cardiac Catheterization
Cardiac Surgical Procedures
Cardiotonic Agents
Critical Care
Heart Defects, Congenital
Humans
Infant, Newborn
Preoperative Care
Respiration, Artificial
Vasoconstrictor Agents
Vasodilator Agents