Hostname: page-component-848d4c4894-sjtt6 Total loading time: 0 Render date: 2024-06-16T19:54:48.008Z Has data issue: false hasContentIssue false
  • English
  • Français

Anaesthesia management of interventional cardiac catheterisation for pulmonary atresia with intact ventricular septum and critical pulmonary stenosis: a retrospective analysis

Published online by Cambridge University Press:  24 May 2024

Xu Zhang Open the ORCID record for Xu Zhang [Opens in a new window] ,
Ning Zhang ,
Kui-liang Wang  and
Yue-yi Ren
Xu Zhang
Affiliation:
Department of Anesthesiology, Peking University People’s Hospital, Women and Children’s Hospital, Qingdao University, Qingdao, China
Ning Zhang
Affiliation:
Department of Laboratory Medicine, Qingdao Women’s and Children’s Hospital Affiliated to Qingdao University, Qingdao, China
Kui-liang Wang
Affiliation:
Department of Heart Center, Qingdao Women’s and Children’s Hospital Affiliated to Qingdao University, Qingdao, China
Yue-yi Ren*
Affiliation:
Department of Heart Center, Qingdao Women’s and Children’s Hospital Affiliated to Qingdao University, Qingdao, China
*
Corresponding author: Y-y. Ren; Email: xxgmz1173@126.com
Get access Rights & Permissions [Opens in a new window]

Abstract

Objective:

Pulmonary atresia with intact ventricular septum and critical pulmonary stenosis usually have to undergo treatment in the neonatal period. Compared to traditional surgical intervention, catheter-based cardiac interventions may achieve similar or superior outcomes for neonates with pulmonary atresia with intact ventricular septum and critical pulmonary stenosis. However, there is limited literature on anaesthesia techniques, challenges, and risks associated with cardiac catheterisation in this population.

Methods:

This article retrospectively analysed the clinical data of pulmonary atresia with intact ventricular septum and critical pulmonary stenosis neonates who were treated with interventional cardiac catheterisation in our hospital from January 2015 to October 2022. Clinical outcomes considered were haemodynamic or pulse oxygen saturation instability, vasoactive requirements, prolonged intubation (>24 h postoperatively), and cardiovascular adverse events.

Results:

A total of 63 patients met the inclusion criteria. All patients survived the intervention. Among the patients with critical pulmonary stenosis, 40 successfully received percutaneous balloon pulmonary valvuloplasty, while three patients received ductal stenting due to moderate right ventricular dysplasia at the same time. For patients with pulmonary atresia with intact ventricular septum, 17 of the 23 patients successfully underwent percutaneous pulmonary valve perforation and percutaneous balloon pulmonary valvuloplasty. Of these, five patients underwent ductal stenting due to unstable pulmonary blood flow. Three patients only underwent ductal stenting. In addition, three patients received hybrid therapy.

Conclusions:

There are various clinical techniques and risk challenges in the interventional cardiac catheterisation of neonatal pulmonary atresia with intact ventricular septum and critical pulmonary stenosis. However, by mastering the physiological and pathophysiological characteristics of the disease, adequately preparing for the perioperative period, and predicting the procedure process and potential complications, anaesthesia and surgical risks can be effectively managed.

Keywords

pulmonary atresia with intact ventricular septumcritical pulmonary stenosisneonatecatheterisationanaesthesia management
Type
Original Article
Information
Cardiology in the Young , First View , pp. 1 - 8
Check for updates
Copyright
© The Author(s), 2024. Published by Cambridge University Press

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

Barry, OM, Bouhout, I, Turner, ME, Petit, CJ, Kalfa, DM. Transcatheter cardiac interventions in the newborn. J Am Coll Cardiol 2022; 79: 2270–2283.CrossRefGoogle ScholarPubMed
Mortezaeian, H, Khorgami, M, Omidi, N, et al. Percutaneous balloon pulmonary valvuloplasty of critical pulmonary stenosis and severe pulmonary stenosis in neonates and early infancy: a challenge in the cyanotic. J Cardiovasc Thorac Res 2021; 13: 156–161.CrossRefGoogle ScholarPubMed
Tseng, SY, Truong, VT, Peck, D, et al. Patent ductus arteriosus stent versus surgical aortopulmonary shunt for initial palliation of cyanotic congenital heart disease with ductal-dependent pulmonary blood flow: a systematic review and meta-analysis. J Am Heart Assoc 2022; 11: e024721.CrossRefGoogle ScholarPubMed
Cheung, EW, Mastropietro, CW, Flores, S, et al. Procedural outcomes of pulmonary atresia with intact ventricular septum in neonates: a multicenter study. Ann Thorac Surg 2023; 115: 1470–1477.CrossRefGoogle ScholarPubMed
Alakhfash, AA, Jelly, A, Almesned, A, et al. Cardiac catheterisation interventions in neonates and infants less than three months. J Saudi Heart Assoc 2020; 32: 149–156.CrossRefGoogle ScholarPubMed
Kamalı, H, Tanıdır, İ.C, Erdem, A, Sarıtaş, T, Güzeltaş, A. The use of chronic total occlusion (CTO) wires for perforation of atretic pulmonary valve; two centers experience. Pediatr Cardiol 2021; 42: 1041–1048.CrossRefGoogle ScholarPubMed
Quinn, BP, Yeh, M, Gauvreau, K, et al. Procedural risk in congenital cardiac catheterization (PREDIC3T). J Am Heart Assoc 2022; 11: e022832.CrossRefGoogle ScholarPubMed
Melekoglu, AN, Baspinar, O. Transcatheter cardiac interventions in neonates with congenital heart disease: a single center experience. J Int Med Res 2019; 47: 615–625.CrossRefGoogle Scholar
Petit, CJ, Qureshi, AM, Glatz, AC, et al. Technical factors are associated with complications and repeat intervention in neonates undergoing transcatheter right ventricular decompression for pulmonary atresia and intact ventricular septum: results from the congenital catheterisation research coll. Cardiol Young 2018; 28: 1042–1049.CrossRefGoogle Scholar
Gleich, S, Latham, GJ, Joffe, D, Ross, FJ. Perioperative and anesthetic considerations in pulmonary atresia with intact ventricular septum. Semin Cardiothorac Vasc Anesth 2018; 22: 256–264.CrossRefGoogle ScholarPubMed
Toganel, R. Critical congenital heart diseases as lifethreatening conditions in the emergency room. J Cardiovasc Emerg 2016; 2: 7–10.Google Scholar
Smith-Parrish, M, Vargas Chaves, DP, Taylor, K, et al. Analgesia, sedation, and anesthesia for neonates with cardiac disease. Pediatrics 2022; 150: e2022056415K.CrossRefGoogle ScholarPubMed
Tierney, N, Kenny, D. Greaney D.Anaesthesia for the paediatric patient in the cardiac catheterisation laboratory. BJA Educ 2022; 22: 60–66.CrossRefGoogle Scholar
Subramaniam, R. Anaesthetic concerns in preterm and term neonates. Indian J Anaesth 2019; 63: 771–779.CrossRefGoogle ScholarPubMed
Taggart, NW, Gordon, BM, Morgan, GJ, Goldstein, BH. Variation in anticoagulation practices in the congenital cardiac catheterization lab: results of a multinational PICES survey. Pediatr Cardiol 2019; 40: 53e60–60.CrossRefGoogle ScholarPubMed
Zhang, X, Zhang, N, Song, HC, Ren, YY. Management of ductal spasm in a neonate with pulmonary atresia and an intact ventricular septum during cardiac catheterization: a case report. World J Clin Cases 2022; 10: 13015–13021.CrossRefGoogle Scholar
Abdelbaser, I, Mageed, NA, Elmorsy, MM, Elfayoumy, SI. Ultrasound-guided long-axis versus short-axis femoral artery catheterization in neonates and infants undergoing cardiac surgery: a randomized controlled study. J Cardiothorac Vasc Anesth 2022; 36: 677–683.CrossRefGoogle ScholarPubMed
Haddad, RN, Hanna, N, Charbel, R, Daou, L, Chehab, G, Saliba, Z. Ductal stenting to improve pulmonary blood flow in pulmonary atresia with intact ventricular septum and critical pulmonary stenosis after balloon valvuloplasty. Cardiol Young 2019; 29: 492–498.CrossRefGoogle ScholarPubMed
Khalil, M, Jux, C, Rueblinger, L, Behrje, J, Esmaeili, A, Schranz, D. Acute therapy of newborns with critical congenital heart disease. Transl Pediatr 2019; 8: 114–126.CrossRefGoogle ScholarPubMed
Loureiro, P, Cardoso, B, Gomes, IB, Martins, JF, Pinto, FF. Long-term results of percutaneous balloon valvuloplasty in neonatal critical pulmonary valve stenosis: a 20-year, single-centre experience. Cardiol Young 2017; 27: 1314–1322.CrossRefGoogle ScholarPubMed
Yucel, IK, Bulut, MO, Kucuk, M, Balli, S, Celebi, A. Intervention in patients with critical pulmonary stenosis in the ductal stenting era. Pediatr Cardiol 2016; 37: 1037–1045.CrossRefGoogle ScholarPubMed
Kasar, T, Tanıdır, İ.C, Öztürk, E, et al. Arrhythmia during diagnostic cardiac catheterization in pediatric patients with congenital heart disease. Turk Kardiyol Dern Ars 2018; 46: 675–682.Google ScholarPubMed
Odegard, KC, Bergersen, L, Thiagarajan, R, et al. The frequency of cardiac arrests in patients with congenital heart disease undergoing cardiac catheterization. Anesth Analg 2014; 118: 175–182.CrossRefGoogle ScholarPubMed
Agha, HM, Abd-El Aziz, O, Kamel, O, et al. Margin between success and failure of PDA stenting for duct-dependent pulmonary circulation. PLoS One 2022; 17: e0265031.CrossRefGoogle ScholarPubMed
Tadphale, S, Yohannan, T, Kauffmann, T, et al. Accessing femoral arteries less than 3 mm in diameter is associated with increased incidence of loss of pulse following cardiac catheterization in infants. Pediatr Cardiol 2020; 41: 1058–1066.CrossRefGoogle ScholarPubMed
Kou, L, Wang, Q, Long, WA, Tang, F, Li, L. Emerging predictors of femoral artery occlusion after pediatric cardiac catheterization. Sci Rep 2020; 10: 14001.CrossRefGoogle ScholarPubMed
Alexander, J, Yohannan, T, Abutineh, I, et al. Ultrasound-guided femoral arterial access in pediatric cardiac catheterizations: a prospective evaluation of the prevalence, risk factors, and mechanism for acute loss of arterial pulse. Catheter Cardiovasc Interv 2016; 88: 1098–1107.CrossRefGoogle ScholarPubMed
Lawley, C, Hockey, K, Yeo, LL, Liava'a, M, Roberts, P. Increasing use of neonatal catheter intervention for pulmonary atresia with intact ventricular septum: management trends from a single centre. Heart Lung Circ 2022; 31: 549–558.CrossRefGoogle ScholarPubMed
McCrossan, BA, Karayiannis, S, Shields, M, etal, Incidence. Predictors, and outcomes of cardiac perforation during pediatric cardiac catheterization: a retrospective observational study from the congenital cardiac interventional study consortium (CCISC). Pediatr Cardiol 2023; 44: 867–872.CrossRefGoogle ScholarPubMed
Chen, TY, Chen, PW, Wang, JN. Patent ductus arteriosus stenting: ductal dissection and spasm in pulmonary atresia with intact ventricular septum. Cardiol Young 2022; 32: 679–680.CrossRefGoogle ScholarPubMed
Bahaidarah, S, Al-Ata, J, Alkhushi, N, et al. Outcome of ductus arteriosus stenting including vertical tubular and convoluted tortuous ducts with emphasis on technical considerations. Egypt Heart J 2021; 73: 83.CrossRefGoogle ScholarPubMed
Faccini, A, Butera, G. Emergency transcatheter closure of a stented PDA in a patient with pulmonary atresia and intact ventricular septum: be ready for the unexpected!. Clin Case Rep 2017; 6: 317–322.CrossRefGoogle Scholar
De Decker, R, Comitis Smith, CL, Saul, D, Goldfarb, SB, Biko, DM, O.'Byrne, ML. Compression of the left mainstem bronchus by patent ductus arteriosus in neonates under consideration for ductal stenting. Catheter Cardiovasc Interv 2020; 95: 1158–1162.Google Scholar
Fukuda, K, Haramitsu, Y, Yazu, Y, Higashimori, A, Shiotani, S, Yokoi, Y. 3-dimensional electroanatomic mapping during mitraClip procedure. JACC Cardiovasc Interv 2020; 13: e37–e38.CrossRefGoogle ScholarPubMed