Anesthetic management of neonates with congenital complete atrioventricular heart block undergoing pacemaker implantation

Autor: Jan Ammann, Joachim Winter, Ulrich Sunderdiek, Stephan A. Loer
Rok vydání: 2005
Předmět:
Zdroj: Journal of cardiothoracic and vascular anesthesia. 19(2)
ISSN: 1053-0770
Popis: s M 1 i t ARDIAC OUTPUT OF infants depends on a high heart rate (140-160 beats/min), and decreases in heart rate can nly partially be compensated for by increases in stroke volume f the stiff neonatal ventricles. Children with congenital comlete heart block, however, have a low heart rate (often 60 eats/min) and are therefore at increased risk of cardiac failure. his applies particularly to the perioperative period when pharacologically and surgically induced changes in contractility, reload, and afterload occur. Thus, a thorough understanding of he cardiovascular pathophysiology and treatment options of nfants with complete heart block is necessary for adequate erioperative care of these children. The incidence of congenital complete heart block is estiated to range between 0.5 and 1 in 10,000 births.1,2 Heart lock may exist alone or in combination with other congenital alformations.1,2 It is associated with maternal anti-SS-A/Ro nd anti-SS-B/La antibodies, which are transferred via the lacenta and which induce an inflammatory tissue injury within he fetal heart.3 This inflammatory reaction can result in a brosis of the atrioventricular node with subsequent conduction bnormalities as well as a progressive endocardial fibrosis.2-4 In ome infants, not only the atrioventricular node but also the inoatrial node are involved.5 Mothers of these children often uffer from diseases like lupus erythematosus or Sjogren’s yndrome but may also be asymptomatic.1,2,4,6,7 Prenatal echoardiography allows diagnosis within the 24th to 26th week of estation so that therapy can be started in utero.4 Treatment ptions include corticosteroids to prevent further inflammatory issue injury, -sympathomimetics to increase fetal heart rate, lasmapheresis to reduce or eliminate circulating maternal anibodies, and in utero pacing.1,2,7-9 Often, however, the heart lock is irreversible and the affected children require lifelong acemakers, which are implanted within the first weeks of their ives.10-12 Because these children are at an increased periopertive risk for cardiac decompensation, 2 cases of neonates equiring pacemaker implantation are reported and possible mplications for the perioperative management are discussed.
Databáze: OpenAIRE
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