Sedating the child with congenital heart disease
In order to meet the complexity of paediatric PH with increased PVR, a more detailed and age-dependent classification has been proposed by the Paediatric Taskforce of the Pulmonary Vascular Research Institute (Panama 2011) that expanded the term pulmonary arterial hypertension (PAH) to paediatric pulmonary hypertensive vascular disease (PPHVD).4–6In the Netherlands, the incidence and prevalence of idiopathic pulmonary arterial hypertension (IPAH) was estimated to be 0.7 and 4.4 per million children, respectively, whereas PAH associated with congenital heart disease (PAH-CHD) had an assumed incidence of 2.2 and a prevalence of 15.6 per million.7Pathophysiology of CHD with intra-cardiac and extra-cardiac shunts may differ greatly in pre-tricuspid versus post-tricuspid lesions (ie, proximal or distal to the subpulmonary atrioventricular valve in the bloodstream).
are left-to-right (or bidirectional) shunts at a low-pressure level, which lead to volume load on the right ventricle (RV) and pulmonary circulation, without immediate or midterm increase of pulmonary arterial pressure (PAP).
Second, management of Eisenmenger syndrome is still an important question, with recent evidence on the severity of the disease and a more rapidly progressive course than previously described.
Third, the Fontan circulation with no subpulmonary ventricle requires a distinct discussion, definition and classification since even a mild rise in pulmonary vascular resistance may lead to the so-called failing Fontan situation.
Implications: The principal hemodynamic effect of propofol in children with congenital heart defects is a decrease in systemic vascular resistance. PY - 1999/12Y1 - 1999/12N2 - We studied the hemodynamic effects of propofol during elective cardiac catheterization in 30 children with congenital heart disease.
We studied the hemodynamic effects of propofol during elective cardiac catheterization in 30 children with congenital heart disease.
Sixteen patients were without cardiac shunt (Group I), six had left-to-right cardiac shunt (Group II), and eight had right-to-left cardiac shunt (Group III).
In children with cardiac shunt, this results in a decrease in the ratio of pulmonary to systemic blood flow, and it can lead to arterial desaturation in patients with cyanotic heart disease. Sixteen patients were without cardiac shunt (Group I), six had left-to-right cardiac shunt (Group II), and eight had right-to-left cardiac shunt (Group III).
TY - JOURT1 - The hemodynamic effects of propofol in children with congenital heart disease AU - Williams, Glyn D. The mean (±SD) ages were 3.8 ± 3.1 yr (Group I), 3.2 ± 3.7 yr (Group II), and 1.0 ± 0.6 yr (Group III).