Pulmonary Hypertensive Crisis following Pediatric Cardiac Surgery

Abstract

In this clinical study, 146 high risk neonates and infants of less than 5 years of age were monitored to identify and characterize pulmonary hypertensive crises following surgery for congenital heart defects. Monitoring included pulse oximetry and catheter measurements of pulmonary arterial and left atrial pressure. Fifty-one patients had one or more hypertensive crises, from which 11 ultimately died and 40 survived with aggressive vasodilator therapy. Each crisis was associated with a stress event. Crises were difficult to attenuate if not treated rapidly and multiple crises would often follow an initial event. Phenoxybenzamine, oxygen, and nitrates were the most frequently used vasodilators. Postoperative management must be individualized on the basis of the monitored response of the pulmonary circulation.