title: Management of right ventricular outflow tract reactivity following pulmonary valve dilatation under general anesthesia: experience of a medical mission.
abstract: 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.
authors.affiliation: Department of Anesthesiology, Children's Hospital of New York, Columbia University, New York, NY, USA. hkhambatta@nj.rr.com
authors.forename: Hoshang J
authors.initials: HJ
authors.lastname: Khambatta
authors.forename: Mauricio
authors.initials: M
authors.lastname: Velado
authors.forename: Joseph W
authors.initials: JW
authors.lastname: Gaffney
authors.forename: William S
authors.initials: WS
authors.lastname: Schechter
authors.forename: Alfonso
authors.initials: A
authors.lastname: Casta
mesh_terms: 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*
chemical_list: D000319:Adrenergic beta-Antagonists; D011412:Propanolamines; C036604:esmolol