Korean J Crit Care Med.  2015 Feb;30(1):34-37. 10.4266/kjccm.2015.30.1.34.

Effective Postoperative Use of Dexmedetomidine in a Child with Severe Pulmonary Arterial Hypertension Secondary to Congenital Ventricular Septal Defect

• Kim YI

• KMID: 2227699
• DOI: http://doi.org/10.4266/kjccm.2015.30.1.34

Abstract

Although alpha2-adrenoceptor agonists are widely used as postoperative sedatives in adults, the postoperative effects in pediatric patients with secondary pulmonary arterial hypertension (PAH) due to congenital heart disease are not well known. We experienced a case of successful ventilator weaning with continuous intravenous administration of dexmedetomidine (DEX) after surgical correction in a 46-month-old child with congenital ventricular septal defect (VSD) with severe PAH. She underwent VSD closure on cardiopulmonary bypass (CPB). After successful weaning from the CPB, hemodynamics and oxygenation were stabilized on DEX and nitroglycerin in the intensive care unit. The patient was successfully weaned from the ventilator 46 hours after surgery. The transthoracic echocardiogram two weeks after surgery showed a closed VSD with no residual shunt and trivial tricuspid regurgitation (Vmax = 2.5 m/sec) without PAH.

Keyword

congenital heart disease; dexmedetomidine; pulmonary arterial hypertension

MeSH Terms

Administration, Intravenous
Adult
Cardiopulmonary Bypass
Child*
Child, Preschool
Dexmedetomidine*
Heart Defects, Congenital
Heart Septal Defects, Ventricular*
Hemodynamics
Humans
Hypertension*
Hypnotics and Sedatives
Intensive Care Units
Nitroglycerin
Oxygen
Tricuspid Valve Insufficiency
Ventilator Weaning
Ventilators, Mechanical
Weaning
Dexmedetomidine
Hypnotics and Sedatives
Nitroglycerin
Oxygen

Figure

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  Fig. 1. Chest X-ray on admission. Increased pulmonary vascularity, signs of pulmonary edema, and cardiomegaly. RPA: right posterior anterior view.

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  Fig. 2. Preoperative TTE. Large perimembranous VSD with a diameter of 1.5 cm and a left to right shunt (Vmax = 1-1.5 m/ sec). TTE: transthoracic echocardiogram; VSD: ventricular septal defect; CW: continuous wave doppler; PED ECHO: pediatric echocardiography.

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  Fig. 3. Postoperative TTE, two weeks after surgery. Closed VSD with no residual shunt, and trivial TR (Vmax=2.5 m/sec) with no significant PAH. TTE: transthoracic echocardiogram; VSD: ventricular septal defect; TR: tricuspid regurgitation; PAH: pulmonary arterial hypertension; CW: continuous wave doppler; PED ECHO: pediatric echocardiography.

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  Fig. 4. Postoperative chest X-ray, two weeks after surgery. No signs of pulmonary edema, and diminished heart size. RPA: right posterior anterior view.

Reference

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