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Neonatal circulatory failure due to acute hypertensive crisis: clinical and echocardiographic clues.

Abstract：

OBJECTIVE:Circulatory failure due to acute arterial hypertension in the neonatal period is rare. This study was undertaken to assess the clinical and echocardiographic manifestations of circulatory failure resulting from acute neonatal hypertensive crisis. METHODS:Neonatal and cardiology databases from 2007 to 2010 were reviewed. An established diagnosis of circulatory failure due to neonatal hypertension before the age of 14 days was required for inclusion. Six patients were identified. RESULTS:Five patients presented with circulatory failure due to an acute hypertensive crisis. The median age at presentation was 8.5 days (range: 6.0-11.0) with a median body weight of 3.58 kg (range: 0.86-4.70). Echocardiography demonstrated mild left ventricular dysfunction [median shortening fraction (SF) 25%, range 10-30] and mild aortic regurgitation in 83% (5/6) of patients. One patient with left ventricular dysfunction (SF = 17%) had a large apical thrombus. Two patients were hypotensive, and hypertension only became evident after restoration of cardiac output. Administration of intravenous milrinone was successful, with rapid improvement of the clinical condition. Left ventricular function normalised in all survivors. CONCLUSION:Early neonatal circulatory collapse due to arterial hypertension is a rare but potentially life-threatening condition. At presentation, hypotension, especially in the presence of a dysfunctional left ventricle, does not exclude a hypertensive crisis being the cause of circulatory failure. The echocardiographic presence of mild aortic regurgitation combined with left ventricular hypocontractility in a structurally normal heart should alert the physician to the presence of underlying hypertension.

journal_name

Cardiovasc J Afr

journal_title

Cardiovascular journal of Africa

authors

Louw J,Brown S,Thewissen L,Smits A,Eyskens B,Heying R,Cools B,Levtchenko E,Allegaert K,Gewillig M

doi

10.5830/CVJA-2013-003

subject

Has Abstract

pub_date

2013-04-01 00:00:00

pages

72-5

issue

3

eissn

1995-1892

issn

1680-0745

journal_volume

24

pub_type

杂志文章

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