Management of right ventricular outflow tract reactivity following pulmonary valve dilatation under general anesthesia: experience of a medical mission.
During a recent volunteer medical mission to the Dominican Republic, we administered anesthesia to a child with severe pulmonary valvular stenosis and suprasystemic right ventricular pressure. This patient underwent a balloon pulmonary valvuloplasty but then developed worsening right ventricular outflow tract obstruction that required immediate therapy to prevent a low cardiac output state. As the development of hyperdynamic right ventricular outflow tract obstruction cannot be predicted, we emphasize the need for preemptive hydration and beta-blockade therapy prior to balloon dilatation.
Khambatta
Hoshang J
HJ
Department of Anesthesiology, Children's Hospital of New York, Columbia University, New York, NY, USA. hkhambatta@nj.rr.com
Velado
Mauricio
M
Gaffney
Joseph W
JW
Schechter
William S
WS
Casta
Alfonso
A
D000293:Adolescent; D000319:Adrenergic beta-Antagonists / Q000627:therapeutic use; D000768:Anesthesia, General; D002404:Catheterization; D004293:Dominican Republic; D004452:Echocardiography; D005260:Female; D006801:Humans; D008493:Medical Missions; D011412:Propanolamines / Q000627:therapeutic use; D011666:Pulmonary Valve Stenosis / Q000601:surgery*; D014694:Ventricular Outflow Obstruction / Q000188:drug therapy*
D000319:Adrenergic beta-Antagonists; D011412:Propanolamines; C036604:esmolol