title: Preoperative management of the neonate with critical aortic valvar stenosis.
abstract: Neonatal critical aortic stenosis is a rare form of CHD that often presents with cardiogenic shock. Although surgical and cardiac catheterisation-based interventions have been successful in alleviating left ventricular outflow tract obstruction, it remains associated with high morbidity and mortality. Critical aortic stenosis results in elevated left ventricular wall stress, which ultimately increases myocardial oxygen consumption and disrupts coronary artery perfusion during diastole, leading to ventricular dysfunction and cardiogenic shock. Critical care management before definitive intervention should be tailored to optimising oxygen delivery and reducing metabolic consumption of the myocardium and peripheral organ systems. This can be accomplished with prostaglandin infusion to maintain system perfusion through patency of the arterial duct, inotropic support, mechanical ventilation, and central nervous system abrogation. Management should also include a multi-specialty medical team including paediatric cardiothoracic surgeons and paediatric cardiologists with expertise in cardiac catheterisation, imaging, and transplantation.
authors: Department of Pediatrics,Herma Heart Center,Divisions of Cardiology and Critical Care,Medical College of Wisconsin,Children's Hospital of Wisconsin,Milwaukee,Wisconsin,United States of America.
authors: Jeremy T
authors: JT
authors: Affolter
authors: Department of Pediatrics,Herma Heart Center,Divisions of Cardiology and Critical Care,Medical College of Wisconsin,Children's Hospital of Wisconsin,Milwaukee,Wisconsin,United States of America.
authors: Nancy S
authors: NS
authors: Ghanayem
mesh_terms: D000527:Alprostadil / Q000627:therapeutic use*; D001024:Aortic Valve Stenosis / Q000151:congenital / Q000628:therapy*; D063126:Balloon Valvuloplasty; D006328:Cardiac Catheterization; D006348:Cardiac Surgical Procedures; D002316:Cardiotonic Agents / Q000627:therapeutic use*; D003422:Critical Care; D006330:Heart Defects, Congenital / Q000628:therapy*; D006801:Humans; D007231:Infant, Newborn; D011300:Preoperative Care / Q000379:methods*; D012121:Respiration, Artificial; D014662:Vasoconstrictor Agents / Q000627:therapeutic use*; D014665:Vasodilator Agents / Q000627:therapeutic use*
chemical_list: D002316:Cardiotonic Agents; D014662:Vasoconstrictor Agents; D014665:Vasodilator Agents; D000527:Alprostadil
keywords: cardiogenic shock