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Iatrogenic ascending aortic obstruction in the neonate: Significance of pressure gradients across the aorta.

Maddali MM - Saudi J Anaesth (2015 Apr-Jun)

View Article: PubMed Central - PubMed

Affiliation: Department of Anesthesia, Royal Hospital, Muscat, Oman.

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The arterial pressures in the right brachial artery were well recordable with good wave form prior to and on CPB... Direct pressure recordings in the ascending aorta proximal to the aortic cannulation site (70/35 mmHg, mean: 45 mmHg) and distal to the arch repair (60/30 mmHg, mean: 40 mmHg) were recorded... As a delayed sternotomy closure was planned, a 22G × 8 cm polyurethane catheter (Vygon [UK] Ltd) was placed in the ascending aorta for direct pressure monitoring... Postoperatively, the brachial artery pressures did not improve... On hypothermic CPB with circulatory arrest (20 min) and with antegrade cerebral perfusion, the earlier aortic cannulation site was widened with a bovine pericardial patch (St. Jude Medical Inc., Minnesota, USA) which abolished the gradients between the ascending aorta, right brachial artery and the femoral artery... The importance of simultaneous invasive arterial pressure monitoring of right upper and lower limbs in neonatal aortic arch repairs has been highlighted earlier... When femoral artery is cannulated, constant vigilance is essential for identifying hypoperfusion related problems and regular Doppler examination would aid in recognizing early changes in perfusion... It is also important that these invasive lines should be removed at the earliest once their purpose is served... Since we did not have a femoral arterial pressure line, a final direct pressure recording of the distal aorta prior to skin approximation, would have identified the problem avoiding a reoperation... In conclusion, arguable as it is and difficult as it may often be, simultaneous monitoring of right upper and lower limb arterial pressures should be considered in surgical correction of hypoplastic aortic arch and coarctation of the aorta... Whenever feasible, interrogation of the ascending aorta and aortic arch by intraoperative transesophageal echocardiography would help in assessing the adequacy of repair as well as identify other surgical conundrums.

No MeSH data available.


Mid-oesophageal ascending aortic long axis view measuring the gradient across the aortic narrowing
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Figure 2: Mid-oesophageal ascending aortic long axis view measuring the gradient across the aortic narrowing

Mentions: Postoperative transesophageal echocardiography (Philips iE33 xMATRIX Ultrasound System with S8-3t micro probe) with color Doppler demonstrated the site of narrowing in the ascending aorta with turbulent flow just below the innominate artery origin [Figure 1] with a 60 mmHg gradient approximately [Figure 2]. The child was transferred to the operating room for a reoperation.


Iatrogenic ascending aortic obstruction in the neonate: Significance of pressure gradients across the aorta.

Maddali MM - Saudi J Anaesth (2015 Apr-Jun)

Mid-oesophageal ascending aortic long axis view measuring the gradient across the aortic narrowing
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4374239&req=5

Figure 2: Mid-oesophageal ascending aortic long axis view measuring the gradient across the aortic narrowing
Mentions: Postoperative transesophageal echocardiography (Philips iE33 xMATRIX Ultrasound System with S8-3t micro probe) with color Doppler demonstrated the site of narrowing in the ascending aorta with turbulent flow just below the innominate artery origin [Figure 1] with a 60 mmHg gradient approximately [Figure 2]. The child was transferred to the operating room for a reoperation.

View Article: PubMed Central - PubMed

Affiliation: Department of Anesthesia, Royal Hospital, Muscat, Oman.

AUTOMATICALLY GENERATED EXCERPT
Please rate it.

The arterial pressures in the right brachial artery were well recordable with good wave form prior to and on CPB... Direct pressure recordings in the ascending aorta proximal to the aortic cannulation site (70/35 mmHg, mean: 45 mmHg) and distal to the arch repair (60/30 mmHg, mean: 40 mmHg) were recorded... As a delayed sternotomy closure was planned, a 22G × 8 cm polyurethane catheter (Vygon [UK] Ltd) was placed in the ascending aorta for direct pressure monitoring... Postoperatively, the brachial artery pressures did not improve... On hypothermic CPB with circulatory arrest (20 min) and with antegrade cerebral perfusion, the earlier aortic cannulation site was widened with a bovine pericardial patch (St. Jude Medical Inc., Minnesota, USA) which abolished the gradients between the ascending aorta, right brachial artery and the femoral artery... The importance of simultaneous invasive arterial pressure monitoring of right upper and lower limbs in neonatal aortic arch repairs has been highlighted earlier... When femoral artery is cannulated, constant vigilance is essential for identifying hypoperfusion related problems and regular Doppler examination would aid in recognizing early changes in perfusion... It is also important that these invasive lines should be removed at the earliest once their purpose is served... Since we did not have a femoral arterial pressure line, a final direct pressure recording of the distal aorta prior to skin approximation, would have identified the problem avoiding a reoperation... In conclusion, arguable as it is and difficult as it may often be, simultaneous monitoring of right upper and lower limb arterial pressures should be considered in surgical correction of hypoplastic aortic arch and coarctation of the aorta... Whenever feasible, interrogation of the ascending aorta and aortic arch by intraoperative transesophageal echocardiography would help in assessing the adequacy of repair as well as identify other surgical conundrums.

No MeSH data available.