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3 results

  • Chapter 14 - Critical Aortic Stenosis

  • from Section 3 - Left-Sided Obstructive Lesions
  • Edited by Laura K. Berenstain, James P. Spaeth
  • Book:
    Congenital Cardiac Anesthesia
    Published online:
    09 September 2021
    Print publication:
    16 September 2021, pp 83-89

  • Summary

    Critical aortic stenosis is defined as the presence of severe aortic valve stenosis with systemic perfusion that is dependent on right ventricular output through a patent ductus arteriosus. Critical aortic stenosis is not defined by an absolute valve area or gradient because in patients with ventricular dysfunction (either systolic or diastolic) it may exist with larger valve areas and gradients may be underestimated. The degree of left ventricular hypertrophy in these neonates, though not as severe as in older patients, still exists, and the ventricle may be dilated and poorly contractile. This chapter discusses available interventions for the neonate with critical aortic stenosis: surgical aortic valvotomy vs. balloon aortic valvuloplasty in the cardiac catheterization laboratory. Preparation for care of the critically ill neonate in the cardiac catheterization laboratory is outlined, as well as perioperative and anesthetic management considerations for a neonate with critical aortic stenosis.

  • Transcarotid balloon aortic valvuloplasty for critical aortic stenosis in an infant weighing 890 g

  • Naomi Nakagawa, Masahiro Kamada, Yuji Moritoh
  • Journal:
    Cardiology in the Young / Volume 31 / Issue 2 / February 2021
    Published online by Cambridge University Press:
    16 November 2020, pp. 294-296
    • Article
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  • We report the smallest case of the balloon aortic valvuloplasty via a carotid artery. A baby boy weighing 890 g suffered from a severe aortic stenosis. Balloon aortic valvuloplasty using a TMP-Ped 4-mm balloon catheter succeeded in resolving severe aortic stenosis without any complications. Balloon aortic valvuloplasty via a carotid artery can be a first-line treatment even for extremely-low-birth-weight infants.

  • Rapid right ventricular pacing for balloon aortic valvuloplasty: expanding its routine use in neonates and infants

  • Konstantinos S. Mylonas, Charalampos Kavvouras, Panagiota Karouli, Dimosthenis Avramidis, Ioannis Papagiannis, David Anderson, Fotios Mitropoulos, Aphrodite Tzifa
  • Journal:
    Cardiology in the Young / Volume 30 / Issue 12 / December 2020
    Published online by Cambridge University Press:
    06 October 2020, pp. 1890-1895
  • Objective:

    Rapid right ventricular pacing during balloon aortic valvuloplasty is commonly used to achieve balloon stability in children and adults. There is no consensus for the use of the technique in neonates and infants. We sought to review our institutional experience with rapid right ventricular pacing-assisted balloon aortic valvuloplasty across all age groups and evaluate the safety and effectiveness of the technique in the sub-group of neonates and infants <12months.

    Methods:

    Retrospective study between February, 2011 and February, 2020.

    Results:

    A total of 37 patients (Group I: 21 neonates/infants <12months and Group II: 16 children 12 months–16 years) were analysed. Catheter-measured left ventricular to aortic gradient reduced from median of 66 mmHg (with a range from 30 to 125 mmHg) to 14 mmHg (with a range from 5 to 44 mmHg) in Group I and 44 mmHg (with a range from 28 to 93 mmHg) to 18 mmHg (with a range from 2 to 65 mmHg) in Group II (p < 0.001). Procedure and fluoroscopy times were identical in the two groups. Balloon:annulus ratio was 0.94 and 0.88 in Groups I and II, respectively. Freedom from reintervention was 100% for Group I at a median time of 3.2 years and 81% at 2.7 years for Group II. Reinterventions in Group II (3/16 pts) were performed predominantly for complex left ventricular outflow tract stenosis. At follow-up echocardiogram, 45% of patients in Group I had no aortic regurgitation, 30% trace-mild, 20% mild-moderate, and 5% moderate aortic regurgitation, whereas in Group II, 50% of patients had no aortic regurgitation, 32% had mild aortic regurgitation, and 18% mild-moderate aortic regurgitation. Unicuspid valves were only encountered in Group 1 (2/21 pts, 10%) and they were predictive of mild-aortic regurgitation during follow-up (p = 0.003). Ventricular fibrillation occurred in three neonates with suspicion of myocardial ischemia on the pre-procedure echocardiogram. All were successfully defibrillated.

    Conclusions:

    Rapid right ventricular pacing can be expanded in neonates and infants to potentially decrease the incidence of aortic regurgitation and reintervention rates, hence avoiding high-risk surgical bail-out procedures for severe aortic regurgitation in the first year of life. Myocardial ischemia may predispose to ventricular dysrhythmias during rapid right ventricular pacing.