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Management of ductal spasm in a neonate with pulmonary atresia and an intact ventricular septum during cardiac catheterization:A case report

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World Journal of Clinical Cases 2022年第35期10卷 13015-13021页

作者： Xu Zhang Ning Zhang Hai-Cheng Song Yue-Yi Ren Department of Heart Center Qingdao Women's and Children's Hospital Affiliated to Qingdao UniversityQingdao 266034Shandong ProvinceChina Department of Medical Technology Qingdao Women's and Children's Hospital Affiliated to Qingdao UniversityQingdao 266034Shandong ProvinceChina

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.

关键词： Cardiac catheterization Ductus arteriosus Ductal stent Ductal spasm intact ventricular septum Pulmonary atresia Case report

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