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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: nghanaye@mcw.edu
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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).

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