Limits...
Neonatal circulatory failure due to acute hypertensive crisis: clinical and echocardiographic clues.

Louw J, Brown S, Thewissen L, Smits A, Eyskens B, Heying R, Cools B, Levtchenko E, Allegaert K, Gewillig M - Cardiovasc J Afr (2013)

Bottom Line: Administration of intravenous milrinone was successful, with rapid improvement of the clinical condition.Left ventricular function normalised in all survivors.The echocardiographic presence of mild aortic regurgitation combined with left ventricular hypocontractility in a structurally normal heart should alert the physician to the presence of underlying hypertension.

View Article: PubMed Central - HTML - PubMed

Affiliation: Paediatric Cardiology, University Hospitals Leuven, Leuven, Belgium.

ABSTRACT

Objective: Circulatory failure due to acute arterial hypertension in the neonatal period is rare. This study was undertaken to assess the clinical and echocardiographic manifestations of circulatory failure resulting from acute neonatal hypertensive crisis.

Methods: Neonatal and cardiology databases from 2007 to 2010 were reviewed. An established diagnosis of circulatory failure due to neonatal hypertension before the age of 14 days was required for inclusion. Six patients were identified.

Results: Five patients presented with circulatory failure due to an acute hypertensive crisis. The median age at presentation was 8.5 days (range: 6.0-11.0) with a median body weight of 3.58 kg (range: 0.86-4.70). Echocardiography demonstrated mild left ventricular dysfunction [median shortening fraction (SF) 25%, range 10-30] and mild aortic regurgitation in 83% (5/6) of patients. One patient with left ventricular dysfunction (SF = 17%) had a large apical thrombus. Two patients were hypotensive, and hypertension only became evident after restoration of cardiac output. Administration of intravenous milrinone was successful, with rapid improvement of the clinical condition. Left ventricular function normalised in all survivors.

Conclusion: Early neonatal circulatory collapse due to arterial hypertension is a rare but potentially life-threatening condition. At presentation, hypotension, especially in the presence of a dysfunctional left ventricle, does not exclude a hypertensive crisis being the cause of circulatory failure. The echocardiographic presence of mild aortic regurgitation combined with left ventricular hypocontractility in a structurally normal heart should alert the physician to the presence of underlying hypertension.

Show MeSH

Related in: MedlinePlus

Prominent coronary arteries. Short-axis image with arrow indicating prominent right coronary artery (A), and left coronary artery (B).
© Copyright Policy - open-access
Related In: Results  -  Collection

License
getmorefigures.php?uid=PMC3721817&req=5

Figure 3: Prominent coronary arteries. Short-axis image with arrow indicating prominent right coronary artery (A), and left coronary artery (B).

Mentions: In one patient with considerable hypocontractility, a thrombus of 5 × 9 mm was observed in the apex of the left ventricle (Fig. 1). Mild to moderate aortic regurgitation was seen in five of the six patients (Fig. 2) and mild to moderate mitral regurgitation (MR) in all (Table 1). All aortic and mitral valves were morphologically normal. Interestingly, the coronary arteries were reported to be more prominent than usual in four patients on visual inspection of the echocardiograms (Fig. 3).


Neonatal circulatory failure due to acute hypertensive crisis: clinical and echocardiographic clues.

Louw J, Brown S, Thewissen L, Smits A, Eyskens B, Heying R, Cools B, Levtchenko E, Allegaert K, Gewillig M - Cardiovasc J Afr (2013)

Prominent coronary arteries. Short-axis image with arrow indicating prominent right coronary artery (A), and left coronary artery (B).
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC3721817&req=5

Figure 3: Prominent coronary arteries. Short-axis image with arrow indicating prominent right coronary artery (A), and left coronary artery (B).
Mentions: In one patient with considerable hypocontractility, a thrombus of 5 × 9 mm was observed in the apex of the left ventricle (Fig. 1). Mild to moderate aortic regurgitation was seen in five of the six patients (Fig. 2) and mild to moderate mitral regurgitation (MR) in all (Table 1). All aortic and mitral valves were morphologically normal. Interestingly, the coronary arteries were reported to be more prominent than usual in four patients on visual inspection of the echocardiograms (Fig. 3).

Bottom Line: Administration of intravenous milrinone was successful, with rapid improvement of the clinical condition.Left ventricular function normalised in all survivors.The echocardiographic presence of mild aortic regurgitation combined with left ventricular hypocontractility in a structurally normal heart should alert the physician to the presence of underlying hypertension.

View Article: PubMed Central - HTML - PubMed

Affiliation: Paediatric Cardiology, University Hospitals Leuven, Leuven, Belgium.

ABSTRACT

Objective: Circulatory failure due to acute arterial hypertension in the neonatal period is rare. This study was undertaken to assess the clinical and echocardiographic manifestations of circulatory failure resulting from acute neonatal hypertensive crisis.

Methods: Neonatal and cardiology databases from 2007 to 2010 were reviewed. An established diagnosis of circulatory failure due to neonatal hypertension before the age of 14 days was required for inclusion. Six patients were identified.

Results: Five patients presented with circulatory failure due to an acute hypertensive crisis. The median age at presentation was 8.5 days (range: 6.0-11.0) with a median body weight of 3.58 kg (range: 0.86-4.70). Echocardiography demonstrated mild left ventricular dysfunction [median shortening fraction (SF) 25%, range 10-30] and mild aortic regurgitation in 83% (5/6) of patients. One patient with left ventricular dysfunction (SF = 17%) had a large apical thrombus. Two patients were hypotensive, and hypertension only became evident after restoration of cardiac output. Administration of intravenous milrinone was successful, with rapid improvement of the clinical condition. Left ventricular function normalised in all survivors.

Conclusion: Early neonatal circulatory collapse due to arterial hypertension is a rare but potentially life-threatening condition. At presentation, hypotension, especially in the presence of a dysfunctional left ventricle, does not exclude a hypertensive crisis being the cause of circulatory failure. The echocardiographic presence of mild aortic regurgitation combined with left ventricular hypocontractility in a structurally normal heart should alert the physician to the presence of underlying hypertension.

Show MeSH
Related in: MedlinePlus