Perioperative and Anesthetic Considerations in Pulmonary Atresia With Intact Ventricular Septum

Gleich, Stephen J.; Latham, Gregory J.; Joffe, Denise; Ross, Faith J.

doi:10.1177/1089253217737180

Cited by 11 publications

(3 citation statements)

References 43 publications

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“…Newborns with PA/IVS and CPS depend on PDA to obtain su cient PBF, requiring PGE1 to maintain PDA patency. Identifying RVDCC through TTE and CT before surgery is very important and affects the next treatment plan and surgical decision [11]. Patients with wider PDA and unrestricted atrial shunting can be placed in regular wards with continuous or discontinuous low-dose PGE1 treatment depending on the condition.…”

Section: Discussionmentioning

confidence: 99%

Anesthesia management of interventional cardiac catheterization for pulmonary atresia with intact ventricular septum (PAIVS) and critical pulmonary stenosis (CPS): a retrospective analysis

Zhang

Wang

et al. 2023

Preprint

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Background Pulmonary atresia with intact ventricular septum (PA/IVS) and critical pulmonary stenosis (CPS) usually have to undergo treatment in the neonatal period, as their pulmonary blood flow (PBF) depends on the patent ductus arteriosus (PDA). Recent studies have shown that catheter-based cardiac interventions may achieve similar or superior outcomes for neonates with PA/IVS and CPS compared to traditional surgical intervention. However, there is limited literature on anesthesia techniques, challenges, and risks associated with cardiac catheterization in this population. Methods This article retrospectively analyzed the clinical data of PA/IVS and CPS neonates who were treated with interventional cardiac catheterization in our hospital from January 2015 to October 2022. A special clinical protocol for anesthetic management of these patients was utilized throughout the study period. Clinical outcomes considered were hemodynamic or SpO2 instability, vasoactive requirements, prolonged intubation (>24 h postoperatively) and cardiovascular adverse events. Results A total of 63 patients met the inclusion criteria. Central venous catheter and invasive arterial blood pressure monitoring were provided for 26 neonates during the perioperative period. All patients survived the intervention. Among the patients with CPS, 40 successfully received percutaneous balloon pulmonary valvuloplasty (PBPV), while three patients received ductal stenting due to moderate right ventricular dysplasia at the same time. For patients with PA/IVS, 17 of the 23 patients successfully underwent percutaneous pulmonary valve perforation (PPVP) and PBPV. Of these, five patients underwent ductal stenting due to unstable PBF. Three patients only underwent ductal stenting. In addition, three patients received hybrid therapy. Compared with CPS, the procedural time and anesthesia time of PA/IVS were significantly prolonged, as were the numbers of patients using prostaglandin E1 and vasoactive drugs in the perioperative period, and postoperative mechanical ventilation time >24 h was also significantly increased. Conclusions There are various clinical techniques and risk challenges in the interventional cardiac catheterization of neonatal PA/IVS and CPS. However, by mastering the physiological and pathophysiological characteristics of the disease, adequately preparing for the perioperative period, predicting the procedure process and potential complications, anesthesia and surgical risks can be effectively managed. Compared with CPS neonates, PA/IVS neonates have a higher perioperative risk and incidence of cardiovascular adverse events.

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Section: Discussionmentioning

confidence: 99%

Anesthesia management of interventional cardiac catheterization for pulmonary atresia with intact ventricular septum (PAIVS) and critical pulmonary stenosis (CPS): a retrospective analysis

Zhang

Wang

et al. 2023

Preprint

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“…Thus, the choice of management algorithm hinges on accurate characterization of the coronary artery anatomy. Thus, PA-IVS patients frequently undergo invasive angiography with aortic root and direct RV injection [ 58 ]. In the case of PA-IVS presented, 4D FE-MRA done on day 2 of life confirmed suspicion of right coronary ostial atresia with origin of the right coronary directly from the apex of the RV ( Figure 12 ).…”

Section: Ferumoxytol-enhanced Mra (Fe-mra) and 4d Phase Contrast Mri ...mentioning

confidence: 99%

Ferumoxytol-Enhanced Cardiac Magnetic Resonance Angiography and 4D Flow: Safety and Utility in Pediatric and Adult Congenital Heart Disease

Renella

Prosper³

et al. 2022

Children

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Cardiac magnetic resonance imaging and angiography have a crucial role in the diagnostic evaluation and follow up of pediatric and adult patients with congenital heart disease. Although much of the information required of advanced imaging studies can be provided by standard gadolinium-enhanced magnetic resonance imaging, the limitations of precise bolus timing, long scan duration, complex imaging protocols, and the need to image small structures limit more widespread use of this modality. Recent experience with off-label diagnostic use of ferumoxytol has helped to mitigate some of these barriers. Approved by the U.S. FDA for intravenous treatment of anemia, ferumoxytol is an ultrasmall superparamagnetic iron oxide nanoparticle that has a long blood pool residence time and high relaxivity. Once metabolized by macrophages, the iron core is incorporated into the reticuloendothelial system. In this work, we aim to summarize the evolution of ferumoxytol-enhanced cardiovascular magnetic resonance imaging and angiography and highlight its many applications for congenital heart disease.

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“…Chikkabyrappa and colleagues describe the perioperative physiology, imaging and management of pulmonary atresia with an intact ventricular septum (PA-IVS) with an accompanying article by Gleich and colleagues describing the perioperative anesthetic considerations. 4,5 Together, these 2 articles describe this rare, complex CHD, which has a wide anatomic and physiologic spectrum. Chikkabyrappa and colleagues show an excellent pathology specimen of PA-IVS as well as wonderful echocardiographic and angiography images.…”

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confidence: 99%

Thomas Bevill Peacock and the First Descriptions of Congenital Heart Disease

Twite

Kertai

Weitzel

2018

Semin Cardiothorac Vasc Anesth

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School" who emphasized clinicopathological correlation and enthusiastically used Laennec's recent invention, the stethoscope. This instrument revolutionized the diagnosis of diseases of the chest and led to unprecedented interest in disorders of the heart.Peacock eventually practiced medicine at St Thomas's Hospital, London. He was highly regarded as a teacher and a popular lecturer. Many of Peacock's lectures and papers dealt with anomalies and diseases of the cardiovascular system. His book, On Malformations of the Human Heart is considered to be the first account to present congenital heart disease (CHD) in an organized fashion. Unlike many of his contemporaries who wrote about CHD cases in haphazard fashion because of a lack of pathophysiologic principles, Peacock combined anatomy and embryology to classify CHD into 4 categories: misplacements of the heart, pericardial abnormalities, cardiac malformations, and irregularities of primary vessels. 3 Peacock's book was well written, included 5 engravings depicting congenital cardiac malformations and was supplemented by useful bibliographies. In a careful analysis of more than 100 cases of CHD for which clinical information was available, Peacock found that three-quarters of the patients had symptoms at birth or shortly thereafter and half of the remainder became symptomatic during the first year of life.This issue of the journal brings together 8 articles relevant to the practice of congenital cardiac anesthesia. Six articles review the clinicopathological aspects of pulmonary atresia with an intact ventricular septum, truncus arteriosus, and interrupted aortic arch. The remaining 2 articles are original studies about the airway in children with CHD. The review articles are very consistent with Peacock's work describing the embryology, anatomy, and clinical relevance of congenital heart lesions. What Peacock could not imagine is the modern era of imaging these abnormalities with echocardiography, computed tomography (CT) scans, cardiac magnetic resonance imaging (cMRI), and the current therapeutic options in the cardiac catheterization laboratory and surgical approaches. Chikkabyrappa and colleagues describe the perioperative physiology, imaging and management of pulmonary atresia with an intact ventricular septum (PA-IVS) with an accompanying article by Gleich and colleagues describing the perioperative anesthetic considerations. 4,5 Together, these 2 articles 788914S CVXXX10.1177/1089253218788914Seminars in Cardiothoracic and Vascular AnesthesiaTwite et al editorial2018

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Perioperative and Anesthetic Considerations in Pulmonary Atresia With Intact Ventricular Septum

Cited by 11 publications

References 43 publications

Anesthesia management of interventional cardiac catheterization for pulmonary atresia with intact ventricular septum (PAIVS) and critical pulmonary stenosis (CPS): a retrospective analysis

Anesthesia management of interventional cardiac catheterization for pulmonary atresia with intact ventricular septum (PAIVS) and critical pulmonary stenosis (CPS): a retrospective analysis

Ferumoxytol-Enhanced Cardiac Magnetic Resonance Angiography and 4D Flow: Safety and Utility in Pediatric and Adult Congenital Heart Disease

Thomas Bevill Peacock and the First Descriptions of Congenital Heart Disease

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