Zhang X, Zhang N, Song HC, Ren YY. Management of ductal spasm in a neonate with pulmonary atresia and an intact ventricular septum during cardiac catheterization: A case report. World J Clin Cases 2022; 10(35): 13015-13021 [PMID: 36568995 DOI: 10.12998/wjcc.v10.i35.13015]
Corresponding Author of This Article
Yue-Yi Ren, MD, Chief Physician, Department of Heart Center, Qingdao Women's and Children's Hospital Affiliated to Qingdao University, No. 217 Liaoyang West Road, Shibei District, Qingdao 266034, Shandong Province, China. xxgmz1173@126.com
Research Domain of This Article
Anesthesiology
Article-Type of This Article
Case Report
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Clin Cases. Dec 16, 2022; 10(35): 13015-13021 Published online Dec 16, 2022. doi: 10.12998/wjcc.v10.i35.13015
Management of ductal spasm in a neonate with pulmonary atresia and an intact ventricular septum during cardiac catheterization: A case report
Xu Zhang, Ning Zhang, Hai-Cheng Song, Yue-Yi Ren
Xu Zhang, Hai-Cheng Song, Yue-Yi Ren, Department of Heart Center, Qingdao Women's and Children's Hospital Affiliated to Qingdao University, Qingdao 266034, Shandong Province, China
Ning Zhang, Department of Medical Technology, Qingdao Women's and Children's Hospital Affiliated to Qingdao University, Qingdao 266034, Shandong Province, China
Author contributions: Zhang X and Ren YY drafted and revised the manuscript; Zhang N and Song HC collected all the data related to the case report; all authors read and approved the final manuscript.
Informed consent statement: Written informed consent was obtained from the patient’s parent or guardian for publication of this case report and any accompanying images.
Conflict-of-interest statement: The authors declare that they have no conflicts of interest.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Yue-Yi Ren, MD, Chief Physician, Department of Heart Center, Qingdao Women's and Children's Hospital Affiliated to Qingdao University, No. 217 Liaoyang West Road, Shibei District, Qingdao 266034, Shandong Province, China. xxgmz1173@126.com
Received: August 1, 2022 Peer-review started: August 1, 2022 First decision: October 17, 2022 Revised: October 29, 2022 Accepted: November 22, 2022 Article in press: November 22, 2022 Published online: December 16, 2022
Abstract
BACKGROUND
Ductal spasm is a rare but life-threatening complication of cardiac catheterization in neonates with pulmonary atresia and an intact ventricular septum. In patients with ductal-dependent pulmonary blood flow, ductal spasm may lead to refractory hypoxemia and severe hemodynamic instability, which need to be treated in perfect order.
CASE SUMMARY
We present a male infant with a gestational age of 39 wk, and his fetal echocardiography showed pulmonary atresia. At 28 d of age, transcatheter pulmonary valvuloplasty with balloon dilatation was performed. Two hours after the operation, the patient's pulse oxygen saturation continued to decrease. The patient was then transferred to receive cardiac catheterization. During catheterization, the invasive blood pressure and pulse oxygen saturation suddenly decreased, and repeated aortography revealed partial occlusion of the ductus arteriosus. It no longer changed when pulse oxygen saturation rose to 51% after approximately 20 min of maintenance therapy. Therefore, a ductal stent was used for implantation. Hemodynamics and hypoxemia were improved.
CONCLUSION
We should know that ductal spasm may occur during pulmonary atresia and intact ventricular septum cardiac catheterization. Understand the pathophysiology of ductal-dependent pulmonary blood flow and make comprehensive perioperative preparations essential to deal with hemodynamic disorders caused by ductal spasm.
Core Tip: In patients with ductal-dependent pulmonary blood flow, ductal spasm may lead to refractory hypoxemia and severe hemodynamic instability. Ductal stenting has been widely developed as an initial palliative strategy to secure pulmonary blood flow in such patients. We report a case of a neonate with pulmonary atresia and an intact ventricular septum who developed ductal spasm during ductal stenting. We discussed the appropriate treatment for ductal spasm in a neonate during cardiac catheterization.
