Preoperative Management in Patients with Single-ventricle Physiology

Krushansky, Evonne; Burbano, Nelson H.; Morell, Victor O.; Moguillansky, Diego; Kim, Yeon; Orr, Richard A.; Chrysostomou, Constantinos; Muñoz, Ricardo

doi:10.1111/j.1747-0803.2011.00584.x

Cited by 9 publications

(5 citation statements)

References 10 publications

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“…Milrinone, being an inodilator, would increase the cardiac output and cause dilation of the pulmonary vasculature. [5] Phenylephrine would have caused systemic vasoconstriction and diverts the blood fl ow to the pulmonary circulation.…”

Section: Discussionmentioning

confidence: 99%

Parturient with double outlet right ventricle without pulmonary stenosis: Perioperative management

Singh

Arora

et al. 2012

J Obstet Anaesth Crit Care

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A B S T R A C TDouble outlet right ventricle (DORV) is a rare cardiac condition in which the heart demonstrates single ventricle physiology. The management of these patients depends upon the presence or absence of pulmonary stenosis. They can present as congestive cardia failure on one end and as cyanotic disease on the other extreme. We present a case of DORV without pulmonary stenosis for cesarean section and highlight specifi c management issues in these patients.

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Section: Discussionmentioning

confidence: 99%

Parturient with double outlet right ventricle without pulmonary stenosis: Perioperative management

Singh

Arora

et al. 2012

J Obstet Anaesth Crit Care

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“…While their study showed a positive effect, it was in combination with inhaled nitrogen which has been phased out of practice in most institutions, as it is of low impact. 13,17 Milrinone is recognised as a vasodilator, lowering both systemic and pulmonary vascular resistance with hemodynamic benefits to hypoplastic left heart syndrome patients. 18,19 Due to the decrease in systemic vascular resistance, there is some hesitation in using milrinone in patients with borderline hemodynamics.…”

Section: Discussionmentioning

confidence: 99%

“…12 Krushansky demonstrated that pre-operative use of milrinone infusion in conjunction with inhaled nitrogen was able to obtain an adequate balance of systemic and pulmonary blood flow in neonates with single-ventricle physiology. 13 There is significant controversy about whether milrinone impacts pre-and post-operative survival in current literature with conflicting evidence. 14,15 At our institution, it has been our regular practice to initiate a milrinone infusion for neonates with hypoplastic left heart syndrome in the pre-operative period when evidence of metabolic acidosis and pulmonary over-circulation occurs, as evidenced by rising serum lactate and elevated systemic saturation.…”

mentioning

confidence: 99%

Milrinone for treatment of elevated lactate in the pre-operative newborn with hypoplastic left heart syndrome

et al. 2022

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Background: There is a paucity of information reported regarding the use of milrinone in patients with hypoplastic left heart syndrome prior to the Norwood procedure. At our institution, milrinone is initiated in the pre-operative setting when over-circulation and elevated serum lactate levels develop. We aimed to review the responses associated with the administration of milrinone in the pre-operative hypoplastic left heart syndrome patient. Second, we compared patients who received high- versus low-dose milrinone prior to Norwood procedure. Methods: Single-centre retrospective study of patients diagnosed with hypoplastic left heart syndrome between January 2000 and December 2019 who underwent Norwood procedure. Patient characteristics and outcomes were compared. Results: During the study period, 375 patients were identified; 79 (21%) received milrinone prior to the Norwood procedure with median lactate 2.55 mmol/l, and SpO2 93%. Patients who received milrinone were older at the time of Norwood procedure (6 vs. 5 days) and were more likely to be intubated and sedated. In a subset analysis stratifying patients to low- versus high-dose milrinone, median lactate decreased from time of initiation (2.39 vs 2.75 to 1.6 vs 1.8 mmol/l) at 12 hours post-initiation, respectively. Repeated measures analysis showed a significant decrease in lactate levels by 4 hours following initiation of milrinone, that persisted over time, with no significant difference in mean arterial pressure. Conclusions: The use of milrinone in the pre-operative over-circulated hypoplastic left heart syndrome patient is well tolerated, is associated with decreased lactate levels, and was not associated with significant hypotension or worsening of excess pulmonary blood flow.

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“… 4 RV wall motion significantly improved on echocardiography ( Supplementary Video S4 ; available in the online version only) with a RV FAC of 32%. This infant was further stabilized with N 2 inhalation therapy, 7 and bilateral pulmonary artery banding was performed at 5 days of age. He was extubated at 13 days of age, and postoperative recovery was achieved.…”

Section: Case Reportmentioning

confidence: 99%

Paradoxical Continuous Left-to-Right Ductal Shunt during Circulatory Collapse due to Ductal Closure in an Infant with Duct-Dependent Systemic Circulation

Miyahara

Hussein

Nishiguchi

et al. 2022

AJP Rep

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Duct-dependent systemic circulation is accompanied by a right-to-left ductal shunt, at least during systole. Although observations of paradoxical continuous left-to-right shunts in duct-dependent systemic circulation have been reported, the mechanism remains unclear. We report a continuous left-to-right ductal shunt throughout the cardiac cycle during the initial recovery phase from circulatory collapse and right ventricular (RV) dysfunction due to ductal closure in an infant with hypoplastic left heart and severe aortic coarctation. Further recovery improved his RV function and changed the ductal flow from continuous left-to-right to bidirectional, which is usually seen in duct-dependent systemic circulation. Marked RV dysfunction may contribute to the continuous left-to-right ductal shunt. A continuous left-to-right ductal shunt should not be used to rule out duct-dependent systemic circulation.

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Preoperative Management in Patients with Single-ventricle Physiology

Cited by 9 publications

References 10 publications

Parturient with double outlet right ventricle without pulmonary stenosis: Perioperative management

Parturient with double outlet right ventricle without pulmonary stenosis: Perioperative management

Milrinone for treatment of elevated lactate in the pre-operative newborn with hypoplastic left heart syndrome

Paradoxical Continuous Left-to-Right Ductal Shunt during Circulatory Collapse due to Ductal Closure in an Infant with Duct-Dependent Systemic Circulation

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