Skip to main content Accessibility help
×
Hostname: page-component-76fb5796d-dfsvx Total loading time: 0 Render date: 2024-04-25T07:10:55.349Z Has data issue: false hasContentIssue false

Chapter 17 - Supravalvular Aortic Stenosis

from Section 3 - Left-Sided Obstructive Lesions

Published online by Cambridge University Press:  09 September 2021

Laura K. Berenstain
Affiliation:
Cincinnati Children's Hospital Medical Center
James P. Spaeth
Affiliation:
Cincinnati Children's Hospital Medical Center
Get access

Summary

Williams syndrome is a multisystem disorder with a variable clinical presentation resulting from a chromosome 7q11.23 microdeletion including the ELN gene coding for the protein elastin. Eighty percent of patients have cardiovascular abnormalities including supravalvar aortic stenosis, branch and peripheral pulmonary artery stenosis, and coronary artery obstructions. Patients are at high risk for cardiac arrest when undergoing sedation or general anesthesia due to an imbalance in myocardial oxygen supply and demand induced by anesthetic medications. Risk factors for cardiac arrest in the perioperative period are biventricular outflow tract obstruction and coronary artery obstruction by ostial or intraluminal stenosis. Hemodynamic goals include maintaining an age-appropriate heart rate, sinus rhythm, preload, contractility, and systemic vascular resistance. Sedation or general anesthesia for elective procedures should be performed at tertiary care medical centers with immediate access to cardiac specialists and the capability to provide extracorporeal membrane oxygenation support.

Type
Chapter
Information
Congenital Cardiac Anesthesia
A Case-based Approach
, pp. 105 - 112
Publisher: Cambridge University Press
Print publication year: 2021

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

References

Williams, J. C. P., Barratt-Boyes, B. G., and Lowe, J. B.. Supravalvular aortic stenosis. Circulation 1961; 24: 1311–18.CrossRefGoogle ScholarPubMed
Beuren, A. J., Apitz, J., and Harmjanz, D.. Supravalvular aortic stenosis in association with mental retardation and a certain facial appearance. Circulation 1962; 26: 1235–40.CrossRefGoogle Scholar
Stromme, P., Bjornstad, P. G., and Ramstad, K.. Prevalence estimation of Williams syndrome. J Child Neurol 2002; 17: 269–71.CrossRefGoogle ScholarPubMed
Twite, M. D., Stenquist, S., and Ing, R. J.. Williams syndrome. Pediatr Anesth 2019; 29: 483–90.CrossRefGoogle ScholarPubMed
Taylor, D. and Habre, W.. Risk associated with anesthesia for noncardiac surgery in children with congenital heart disease. Pediatr Anesth 2019; 29: 426–34.CrossRefGoogle ScholarPubMed
Ewart, A. K., Morris, C. A., Atkinson, D., et al. Hemizygosity at the elastin locus in a developmental disorder, Williams syndrome. Nat Genet 1993; 5: 1116.CrossRefGoogle Scholar
Urbán, Z., Zhang, J., Davis, E. C., et al. Supravalvular aortic stenosis: genetic and molecular dissection of a complex mutation in the elastin gene. Hum Genet 2001; 109: 512–20.CrossRefGoogle ScholarPubMed
Collins, R. T., Kaplan, P., Somes, G. W., et al. Long-term outcomes of patients with cardiovascular abnormalities and Williams syndrome. Am J Cardiol 2010; 105: 874–8.CrossRefGoogle ScholarPubMed
Horowitz, P. E., Akhtar, S., Wulff, J. A., et al. Coronary artery disease and anesthesia-related death in children with Williams syndrome. J Cardiothorac Vasc Anesth 2002; 16: 739–41.CrossRefGoogle ScholarPubMed
Baum, V. C. and O’Flaherty, J. E.. Anesthesia for Genetic, Metabolic, and Dysmorphic Syndromes of Childhood. 3rd ed. Philadelphia: Wolters Kluwer 2015; 475–6.Google Scholar
Collins, R. T., Aziz, P. F., Gleason, M. M., et al. Abnormalities of cardiac repolarization in Williams syndrome. Am J Cardiol 2010; 106: 1029–33.CrossRefGoogle ScholarPubMed
Latham, G. J., Ross, F. J., Eisses, M. J., et al. Perioperative morbidity in children with elastin arteriopathy. Pediatr Anesth 2016; 26: 926–35.CrossRefGoogle ScholarPubMed
Wessel, A., Gravenhorst, V., Buchhorn, R., et al. Risk of sudden death in the Williams-Beuren syndrome. Am J Med Genet 2004; 127A: 234–7.CrossRefGoogle ScholarPubMed
Hornik, C. P., Collins, R. T., Jaquiss, R. D. B., et al. Adverse cardiac events in children with Williams syndrome undergoing cardiovascular surgery: an analysis of the Society of Thoracic Surgeons Congenital Heart Surgery Database. J Thorac Cardiovasc Surg 2015; 149: 1516–22.CrossRefGoogle Scholar
Bird, L. M., Billman, G. F., Lacro, R. V., et al. Sudden death in Williams syndrome: report of ten cases. J Pediatr 1996; 129: 926–31.CrossRefGoogle ScholarPubMed
Castañeda, A. R., Jonas, R. A., Mayer, J. E., et al. Cardiac Surgery of the Neonate and Infant. 1st ed. Philadelphia: W.B. Saunders, 1994; 327–32.Google Scholar
Pober, B. R.. Williams-Beuren syndrome. N Engl J Med 2010; 362: 239–52.CrossRefGoogle ScholarPubMed
Medley, J., Russo, P., and Tobias, J. D.. Perioperative care of the patient with Williams syndrome. Pediatr Anesth 2005; 15: 243–7.CrossRefGoogle ScholarPubMed
Committee on Genetics. American Academy of Pediatrics: healthcare supervision for children with Williams syndrome. Pediatrics 2001; 107: 1192–204.Google Scholar
Brown, M. L., Nasr, V. G., Toohey, R., et al. Williams syndrome and anesthesia for non-cardiac surgery: high risk can be mitigated with appropriate planning. Pediatr Cardiol 2018; 39: 1123–8.CrossRefGoogle ScholarPubMed
Collins, R. T., Collins, M. G., Schmitz, M. L., et al. Peri-procedural risk stratification and management of patients with Williams syndrome. Congenit Heart Dis 2017; 12: 133–42.CrossRefGoogle Scholar

Suggested Reading

Brown, M. L., Nasr, V. G., Toohey, R., et al. Williams syndrome and anesthesia for non-cardiac surgery: high risk can be mitigated with appropriate planning. Pediatr Cardiol 2018; 39: 1123–28.CrossRefGoogle ScholarPubMed
Burch, T. M., McGowan, F. X., Kussman, B. D., et al. Congenital supravalvular aortic stenosis and sudden death associated with anesthesia: what’s the mystery? Anesth Analg 2008; 107: 1848–54.CrossRefGoogle ScholarPubMed
Collins, R. T., Collins, M. G., Schmitz, M. L., et al. Peri-procedural risk stratification and management of patients with Williams syndrome. Congenit Heart Dis 2017; 12: 133–42.CrossRefGoogle Scholar
Latham, G. J., Ross, F. J., Eisses, M. J., et al. Perioperative morbidity in children with elastin arteriopathy. Pediatr Anesth 2016; 26: 926–35.CrossRefGoogle ScholarPubMed
Matisoff, A. J., Olivieri, L., Schwartz, J. M., et al. Risk assessment and anesthetic management of patients with Williams syndrome: a comprehensive review. Pediatr Anesth 2015; 25: 1207–15.CrossRefGoogle ScholarPubMed
Pober, B. R. Williams-Beuren syndrome. N Engl J Med 2010; 362: 239–52.CrossRefGoogle ScholarPubMed
Twite, M. D., Stenquist, S., and Ing, R. J. Williams syndrome. Pediatr Anesth 2019; 29: 483–90.CrossRefGoogle ScholarPubMed

Save book to Kindle

To save this book to your Kindle, first ensure coreplatform@cambridge.org is added to your Approved Personal Document E-mail List under your Personal Document Settings on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part of your Kindle email address below. Find out more about saving to your Kindle.

Note you can select to save to either the @free.kindle.com or @kindle.com variations. ‘@free.kindle.com’ emails are free but can only be saved to your device when it is connected to wi-fi. ‘@kindle.com’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.

Find out more about the Kindle Personal Document Service.

Available formats
×

Save book to Dropbox

To save content items to your account, please confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account. Find out more about saving content to Dropbox.

Available formats
×

Save book to Google Drive

To save content items to your account, please confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account. Find out more about saving content to Google Drive.

Available formats
×