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Chapter 14 - Critical Aortic Stenosis

from Section 3 - Left-Sided Obstructive Lesions

Published online by Cambridge University Press:  09 September 2021

By
Vannessa Chin
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

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.

Keywords

anesthesiaballoon aortic valvuloplastycritical aortic stenosissurgical aortic valvotomy
Type
Chapter
Information
Congenital Cardiac Anesthesia
A Case-based Approach
 , pp. 83 - 89
Publisher: Cambridge University Press
Print publication year: 2021

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References

References

Saung, M. T., McCracken, C., Sachdeva, R., et al. Outcomes following balloon aortic valvuloplasty vs surgical valvotomy in congenital aortic valve stenosis: a meta-analysis. J Invasive Cardiol 2019; 31: E133–44.Google Scholar
Ewert, P., Bertram, H., Breuer, J., et al. Balloon valvuloplasty in the treatment of congenital aortic valve stenosis: a retrospective multicenter survey of more than 1000 patients. Int J Cardiol 2011; 149: 182–185.CrossRefGoogle ScholarPubMed
Nykanen, D. G., Forbes, T. J., Du, W., et al. CRISP: catheterization risk score for pediatrics: a report from the congenital cardiac interventional study consortium (CCISC). Catheter Cardio Inte 2016; 87: 302–9.CrossRefGoogle ScholarPubMed
Ramamoorthy, C., Haberkern, C. M., Bhananker, S. M., et al. Anesthesia-related cardiac arrest in children with heart disease: data from the pediatric perioperative cardiac arrest (POCA) registry. Anesth Analg 2010; 110: 1376–82.Google Scholar
Odegard, K. C., Vincent, R., Baijal, R., et al. SCAI/CCAS/SPA expert consensus statement for anesthesia and sedation practice: recommendations for patients undergoing diagnostic and therapeutic procedures in the pediatric and congenital cardiac catheterization laboratory. Catheter Cardio Inte 2016; 88: 912–22.CrossRefGoogle ScholarPubMed

Suggested Reading

Daaboul, D. G., Dinardo, J. A., and Nasr, V. G. Anesthesia for high-risk procedures in the catheterization laboratory. Pediatric Anesthesia 2019; 29: 491–8.CrossRefGoogle ScholarPubMed
Odegard, K. C., Bergersen, L., Thiagarajan, R., et al. The frequency of cardiac arrests in patients with congenital heart disease undergoing cardiac catheterization. Anesth Analg 2014; 118: 175–82.Google Scholar
Vergnat, M., Asfour, B., Arenz, C., et al. Aortic stenosis of the neonate: a single-center experience. J Thorac and Cardiovasc Surg 2019; 157: 318–26.Google Scholar

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