Preoperative management of the neonate with critical aortic valvar stenosis

Author:

Affolter Jeremy T.,Ghanayem Nancy S.

Abstract

AbstractNeonatal 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.

Publisher

Cambridge University Press (CUP)

Subject

Cardiology and Cardiovascular Medicine,General Medicine,Pediatrics, Perinatology, and Child Health

Cited by 8 articles. 订阅此论文施引文献 订阅此论文施引文献,注册后可以免费订阅5篇论文的施引文献,订阅后可以查看论文全部施引文献

1. Balloon Valvuloplasty in Congenital Critical Aortic Valve Stenosis in Neonates and Infants: A Rescue Procedure for the Left Ventricle;Journal of Cardiovascular Development and Disease;2024-05-18

2. Emergency Hybrid Correction in a Newborn with Critical Aortic Valve Stenosis with Acute Pulmonary Edema in the First Hour after Birth;Congenital Heart Disease;2023

3. Congenital Anomalies of the Aortic Valve;Congenital Heart Disease in Pediatric and Adult Patients;2023

4. Left Ventricular Outflow Tract Obstruction;Critical Care of Children with Heart Disease;2020

5. Variable role of patent ductus arteriosus;Seminars in Fetal and Neonatal Medicine;2018-08

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