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Chapter 6 - Critical Pulmonic Stenosis

from Section 2 - Right-Sided Obstructive Lesions

Published online by Cambridge University Press:  09 September 2021

By
Jennie Ngai
Edited by
Laura K. Berenstain  and
James P. Spaeth
Laura K. Berenstain
Affiliation:
Cincinnati Children's Hospital Medical Center
James P. Spaeth
Affiliation:
Cincinnati Children's Hospital Medical Center
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Summary

During fetal development, little blood flows through the lungs due to high pulmonary vascular resistance. After birth, pulmonary vascular resistance is initially elevated and then decreases over the first few days of life. In normal infants the ductus arteriosus is not needed after birth and begins to functionally close during the first 24–72 hours after birth. It is anatomically closed between the third and fourth week of life. In infants with critical pulmonary valve stenosis, the amount of antegrade blood flow through the pulmonary valve to the pulmonary arteries is limited, and therefore the major source of source of pulmonary blood flow is provided via the ductus arteriosus. As it closes, if antegrade blood flow through the critically stenosed pulmonic valve is not sufficient infants become hypoxemic and may require institution of prostaglandin E1 to maintain ductal flow. Balloon pulmonary valvuloplasty in the cardiac catheterization laboratory is the treatment of choice for the typical dome-shaped valve characteristically seen in pulmonary stenosis. This chapter describes the perioperative considerations and management of an infant with critical pulmonary stenosis undergoing balloon valvuloplasty in the catheterization laboratory.

Keywords

cardiac catheterization laboratoryneonatal critical pulmonary stenosispostnatal diagnosis
Type
Chapter
Information
Congenital Cardiac Anesthesia
A Case-based Approach
 , pp. 33 - 38
Publisher: Cambridge University Press
Print publication year: 2021

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References

Suggested Reading

Dice, J. E. and Bhatia, J. Patent ductus arteriosus: an overview. J Pediatr Pharmacol Ther 2007; 12: 138–46.Google Scholar
Gournay, V. The ductus arteriosus: physiology, regulation, and functional and congenital anomalies. Arch Cardiovasc Dis 2011; 104: 578–85.CrossRefGoogle ScholarPubMed
Laussen, P. C. and Salvin, J. Diagnostic and therapeutic cardiac catheterization. In Furhman, B. and Zimmerman, J., eds. Pediatric Critical Care, 4th ed. Philadelphia, Mosby Elsevier, 2011; 266–76.Google Scholar
Scholz, T. and Reinking, B. E. Congenital heart disease. In Gleason, C. and Juul, S. Avery’s Diseases of the Newborn, 10th ed. Philadelphia: Elsevier, 2018; 801–27.Google Scholar
Singh, Y. and Mikrou, P. Use of prostaglandins in duct-dependent congenital heart conditions. Arch Dis Child Educ Pract Ed 2018; 103: 137–40.Google Scholar
Townsley, M. M. and Martin, D. E. Anesthetic management for the surgical treatment of valvular heart disease. In Hensley, F., Martin, D., and Gravlee, G. A Practical Approach to Cardiac Anesthesia, 5th ed. Philadelphia: Lippincott Williams & Wilkins, 2013; 319–58.Google Scholar

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