Perioperative and Anesthetic Management of Coarctation of the Aorta

2019 ◽  
Vol 23 (2) ◽  
pp. 212-224 ◽  
Author(s):  
Eric B. Fox ◽  
Gregory J. Latham ◽  
Faith J. Ross ◽  
Denise Joffe
Keyword(s):  
Congenital Heart Disease ◽  
Congenital Heart ◽  
Interventional Procedures ◽  
Clinical Presentation ◽  
Surgical Repair ◽  
Anesthetic Management ◽  
Treatment Options ◽  
Balloon Dilation ◽  
Coarctation Of The Aorta ◽  
Interventional Therapy

Isolated coarctation of the aorta is a relatively common form of congenital heart disease that is characterized by variable degrees of obstruction to aortic outflow. The clinical presentation varies from asymptomatic arterial hypertension to cardiogenic shock. The treatment options include surgical repair or interventional therapy with aortic balloon dilation and stent placement. This article will summarize the pathophysiology as well as describe the surgical and interventional procedures. The anesthetic management for those interventions will be reviewed.

scholarly journals Coarctation: A Review

2020 ◽  
Vol 13 (2) ◽  
pp. 99-104
Author(s):  
Marc G Cribbs
Keyword(s):  
Congenital Heart Disease ◽  
Congenital Heart ◽  
Septal Defect ◽  
Surgical Repair ◽  
Treatment Options ◽  
Coarctation Of The Aorta ◽  
Late Complications ◽  
Transcatheter Therapy ◽  
Complex Defect

Coarctation of the aorta occurs in 0.04% of the population, and accounts for approximately 10% of lesions in adults with congenital heart disease. It can occur as an isolated lesion or as a part of a complex defect, and is most commonly associated with bicuspid aortic valve, ventricular septal defect, and mitral valve abnormalities. Since the first surgical repair in 1944, the available treatment options have expanded greatly. Perhaps one of the most important advances in the management of coarctation of the aorta has been the development of transcatheter therapy for both native and especially recurrent coarctation of the aorta. Late complications, even after apparently successful treatment, are not uncommon. For this reason, lifelong follow-up is vital.

Common arterial trunk

2020 ◽  
pp. 303-312
Author(s):  
Justin T Tretter ◽  
Tarek Alsaied ◽  
Andrew N Redington
Keyword(s):  
Congenital Heart Disease ◽  
Heart Disease ◽  
Congenital Heart ◽  
Clinical Presentation ◽  
Surgical Repair ◽  
Anatomical Variation ◽  
Repair Strategy ◽  
Common Presentation ◽  
Common Arterial Trunk ◽  
Arterial Trunk

Common arterial trunk, or truncus arteriosus, is a rare form of congenital heart disease defined by the presence of an arterial trunk which arises from the ventricular mass through a common ventriculo-arterial junction and gives rise to the systemic, pulmonary, and coronary circulations. The anatomical variation and associated cardiac anomalies dictate the clinical presentation and specific surgical repair strategy. This chapter reviews a common presentation of a newborn with common arterial trunk, serving as the basis for discussion of the anatomical variation, physiology, resulting clinical presentation and preoperative management, surgical repair strategy, and outcomes.

Pediatric Ventricular Assist Device Implantation: An Anesthesia Perspective

2021 ◽  
pp. 108925322199854
Author(s):  
Dash F. T. Newington ◽  
Fabrizio De Rita ◽  
Alan McCheyne ◽  
Claire Louise Barker
Keyword(s):  
Congenital Heart Disease ◽  
Heart Disease ◽  
Extracorporeal Membrane Oxygenation ◽  
Congenital Heart ◽  
Anesthetic Management ◽  
Inotropic Support ◽  
Ventricular Assist Devices ◽  
Ventricular Assist ◽  
Membrane Oxygenation ◽  
Delayed Sternal Closure

Background Ventricular assist devices (VADs) are increasingly being implanted in children, yet there is little literature to guide anesthetic management for these procedures. Aims To describe the pediatric population presenting for VAD implantation and the anesthetic management these patients receive. To compare (a) children under and over 12 months of age and (b) children with and without congenital heart disease. Methods Retrospective review of patients aged 0 to 17 years who underwent VAD implantation at a single center between 2014 and 2019. Results Seventy-seven VADs were implanted in 68 patients (46 left VADs, 24 biventricular VADs, 6 right VADs, and 1 univentricular VAD). One procedure was abandoned. Preoperatively, 20 (26%) patients were supported with extracorporeal membrane oxygenation and 57 (73%) patients were ventilated. Intraoperative donor blood products were required in 74 (95%) cases. Postimplantation inotropic support was required in 66 (85%) cases overall and 46 (100%) patients receiving a left VAD. Infants under 12 months were more likely to require preoperative extracorporeal membrane oxygenation (42% vs 19%), have femoral venous access (54% vs 28%), receive an intraoperative vasoconstrictor (42% vs 24%), and have delayed sternal closure (63 vs 22%). Mortality was higher in patients under 12 months (25% vs 19%) and in patients with congenital heart disease (25% vs 20%). Conclusions Children undergoing VAD implantation require high levels of preoperative organ support, high-dose intraoperative inotropic support, and high-volume blood transfusion. Children under 12 months and those with congenital heart disease are particularly challenging for anesthesiologists and have worse overall outcomes.

Dilatable Pulmonary Artery Banding Palliation in Congenital Heart Disease

2021 ◽  
Vol 12 (2) ◽  
pp. 213-219
Author(s):  
R. Allen Ligon ◽  
Larry A. Latson ◽  
Mark M. Ruzmetov ◽  
Kak-Chen Chan ◽  
Immanuel I. Turner ◽  
...  
Keyword(s):  
Congenital Heart Disease ◽  
Blood Flow ◽  
Heart Disease ◽  
Pulmonary Artery ◽  
Pulmonary Blood Flow ◽  
Congenital Heart ◽  
Balloon Dilation ◽  
Retrospective Chart Review ◽  
Pulmonary Artery Banding ◽  
Surgical Removal

Background: Surgical pulmonary artery banding (PAB) has been limited in practice because of later requirement for surgical removal or adjustment. The aim of this study is to describe our experience creating a dilatable PAB via transcatheter balloon dilation (TCBD) in congenital heart disease (CHD) patients. Methods: Retrospective chart review of adjustable PAB—outline anatomical variants palliated and patient outcomes. Results: Sixteen patients underwent dilatable PAB—median age 52 days (range 4-215) and weight 3.12 kg (1.65-5.8). Seven (44%) of the patients were premature, 11 (69%) had ventricular septal defect(s) with pulmonary over-circulation, four (25%) atrioventricular septal defects, and four (25%) single ventricle physiology. Subsequent to the index procedure: five patients have undergone intracardiac complete repair, six patients remain well palliated with no additional intervention, and four single ventricles await their next palliation. One patient died from necrotizing enterocolitis (unrelated to PAB) and one patient required a pericardiocentesis postoperatively. Five patients underwent TCBD of the PAB without complication—Two had one TCBD, two had two TCBD, and another had three TCBD. The median change in saturation was 14% (complete range 6-22) and PAB diameter 1.7 mm (complete range 1.1-5.2). Median time from PAB to most recent outpatient follow-up was 868 days (interquartile range 190-1,079). Conclusions: Our institution has standardized a PAB technique that allows for transcatheter incremental increases in pulmonary blood flow over time. This methodology has proven safe and effective enough to supplant other institutional techniques of limiting pulmonary blood flow in most patients—allowing for interval growth or even serving as the definitive palliation.

scholarly journals Computational Analysis of the Pulmonary Arteries in Congenital Heart Disease: A Review of the Methods and Results

2021 ◽  
Vol 2021 ◽  
pp. 1-10
Author(s):  
M. Conijn ◽  
G. J. Krings
Keyword(s):  
Congenital Heart Disease ◽  
Heart Disease ◽  
Boundary Conditions ◽  
Congenital Heart ◽  
Treatment Options ◽  
Pulmonary Arteries ◽  
Original Research ◽  
Numerical Studies ◽  
Computational Fluid Dynamics Cfd ◽  
Definition Of

With the help of computational fluid dynamics (CFD), hemodynamics of the pulmonary arteries (PA’s) can be studied in detail and varying physiological circumstances and treatment options can be simulated. This offers the opportunity to improve the diagnostics and treatment of PA stenosis in biventricular congenital heart disease (CHD). The aim of this review was to evaluate the methods of computational studies for PA’s in biventricular CHD and the level of validation of the numerical outcomes. A total of 34 original research papers were selected. The literature showed a great variety in the used methods for (re) construction of the geometry as well as definition of the boundary conditions and numerical setup. There were 10 different methods identified to define inlet boundary conditions and 17 for outlet boundary conditions. A total of nine papers verified their CFD outcomes by comparing results to clinical data or by an experimental mock loop. The diversity in used methods and the low level of validation of the outcomes result in uncertainties regarding the reliability of numerical studies. This limits the current clinical utility of CFD for the study of PA flow in CHD. Standardization and validation of the methods are therefore recommended.

Stent Implantation to Maintain Patency of a Stenosed Blalock Taussig Shunt

2005 ◽  
Vol 13 (3) ◽  
pp. 274-276 ◽  
Author(s):  
Amjad Kouatli ◽  
Jameel Al-Ata ◽  
M Omar Galal ◽  
Muhammed A Amin ◽  
Arif Hussain
Keyword(s):  
Congenital Heart Disease ◽  
Heart Disease ◽  
Oxygen Saturation ◽  
Stent Implantation ◽  
Congenital Heart ◽  
Balloon Dilation ◽  
Complex Congenital Heart Disease ◽  
Blalock Taussig Shunt

A 14-year-old female with complex congenital heart disease underwent a left-sided classical Blalock Taussig (BT) shunt 15 days after birth. Ten years after the operation her oxygen saturation had decreased significantly. An angiography revealed a severely stenosed BT shunt. Balloon dilation including implantation of a 6 × 13 mm stent was performed successfully. Immediately after intervention, oxygen saturation rose from 55% to 80 84% in room air. Follow-up at a year and a half later showed the classical BT shunt was still patent.

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