Published online Dec 16, 2022. doi: 10.12998/wjcc.v10.i35.13015
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
Processing time: 134 Days and 18.9 Hours
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.
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.
We should know that ductal spasm may occur during pulmonary atresia and intact ventricular septum cardiac catheterization. Understand the pathophy
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.