cardiovascular-agents and Cyanosis

Botallo's duct connects the systemic and pulmonary circulation. It can play a crucial hemodynamic role in some cardiac and respiratory diseases of the newborn, and strongly influences the outcome if it remains patent after birth or if it closes rapidly. The recently acquired in-depth knowledge on the genesis of these events have advanced the so called ''pharmacological manipulation of Botallo's duct'', i.e. pharmacological treatment to regulate the opening or closure of the ductus depending on clinical requirements and that, as will be described, is a key issue in managing newborns with severe cardiac and/or respiratory distress. This study illustrates the main underlying mechanisms of duct patency during intrauterine life and its closure after birth, and then describes the clinical conditions of the newborn where Botallo's duct must be kept patent after birth (duct-dependent cardiac malformations) and where its closure must be accelerated (patent duct associated idiopathic respiratory syndrome). It also reports the recent findings on the use of prostaglandins (PGE1) and prostaglandin synthesis inhibitors (indomethacin, ibuprofen) and the potential use of drugs capable of favouring or inhibiting nitric oxide in the duct endothelium.

Topics: Alprostadil; Anti-Inflammatory Agents, Non-Steroidal; Cardiovascular Agents; Cerebral Angiography; Cyanosis; Cyclooxygenase Inhibitors; Ductus Arteriosus; Ductus Arteriosus, Patent; Heart Defects, Congenital; Heart Failure; Hemodynamics; Humans; Ibuprofen; Indomethacin; Infant, Newborn; Infant, Premature, Diseases; Respiratory Distress Syndrome, Newborn; Vasodilator Agents

Topics: Arrhythmias, Cardiac; Cardiac Surgical Procedures; Cardiovascular Agents; Cyanosis; Diagnostic Techniques, Cardiovascular; Female; Humans; Hypoxia; Infant, Newborn; Male; Pacemaker, Artificial; Postoperative Complications; Pulmonary Valve Insufficiency; Respiration, Artificial; Tetralogy of Fallot

Balloon atrial septostomy is ordinarily a safe palliative procedure for cyanotic congenital heart disease; however, if echocardiographic guidance is unavailable and fluoroscopy is used, distortions in the cardiac anatomy can invalidate the usual landmarks. Herein, we report iatrogenic mitral papillary muscle rupture during balloon atrial septostomy in a 4-day-old male neonate with total anomalous connection of the pulmonary veins. The anomalous connection and severe mitral regurgitation were emergently corrected, and the patient grew and developed normally. At age 24 years, he had only mild residual mitral regurgitation and was in New York Heart Association functional class I.In addition to describing the surgical treatment and positive late outcome of a rare complication, we highlight the importance of accurately evaluating balloon catheter location during atrial septostomy, especially in patients with a small left atrium.

Topics: Cardiac Surgical Procedures; Cardiovascular Agents; Catheterization; Cyanosis; Echocardiography, Transesophageal; Heart Defects, Congenital; Heart Failure; Heart Injuries; Humans; Iatrogenic Disease; Infant, Newborn; Male; Mitral Valve; Mitral Valve Insufficiency; Palliative Care; Severity of Illness Index; Time Factors; Treatment Outcome; Young Adult

Emergencies in pediatric cardiology are heart failure, cyanosis and rhythm disturbances. The signs of heart failure are tachycardia, tachypnea and hepatomegaly. The therapy consists of oxygen, diuretics and digoxin. Occasionally, intubation with mechanical ventilation and intravenous catecholamines are needed. Cyanosis is often the only sign of a severe heart malformation, and prompt hospitalization is mandatory. Oxygen and warm environment is important during transport, correction of a possible metabolic acidosis and prostaglandin infusion are done in the hospital. Beyond the newborn period, so-called cyanotic spells are seen, particularly in tetralogy of Fallot. In supraventricular tachycardia, vagal manoeuvres can be tried first, if not successful, intravenous adenosine or electroconversion will restore sinus rhythm. In the older child, intravenous isoptin can be given. Slow heart rates from total AV block or sinus node affection are treated with atrophic, isuprel or electrical pacing.

Topics: Arrhythmias, Cardiac; Cardiovascular Agents; Child; Child, Preschool; Combined Modality Therapy; Critical Care; Cyanosis; Drug Therapy, Combination; Heart Defects, Congenital; Heart Failure; Humans; Infant; Infant, Newborn

Topics: Cardiovascular Agents; Child; Cyanosis; Drug-Related Side Effects and Adverse Reactions; Humans; Infant; Methemoglobinemia; Nitrates