Perioperative management of arteriovenous malformation guided by integrated evaluation of hemodynamics.

Abstract:

:We aimed to demonstrate the value of monitoring infants with arteriovenous malformation (AVM) during endovascular embolization with integrated evaluation of hemodynamics (IEH) and guiding decisions according to the underlying pathophysiology. This is a retrospective analysis of the perioperative hemodynamics data for 2 complex cases of AVM transferred to Khaula Hospital in Oman for interventional management. We described the value of novel physiological insights gained from comprehensive IEH and provided a systematic approach to the perioperative management. Postoperative targeted neonatal echo (TNE) was used to guide the weaning of the cardiovascular medications within 24 h. Both cases showed significant right ventricle (RV) volume overload before surgery. Narrowing of the pulse pressure (PP) during or after endovascular embolization was used as a marker of compromised systemic blood flow in real time followed by an assessment by TNE to guide the appropriate therapy.Conclusion: Integrated evaluation of hemodynamics is helpful to guide perioperative physiologic-based management of AVM. What is Known: • The preoperative management of hemodynamic compromise due to AVM has been described in many articles. • Perioperative management of AVM and related hemodynamics is a challenge to the intensive care team. What is New: • Integrated evaluation of hemodynamics is a comprehensive assessment and helpful in understanding the underlying physiologic changes during intervention with AVM. • This integrated evaluation can lead to physiologic-based medical recommendation with subsequent improvement.

journal_name

Eur J Pediatr

authors

Selim A,El Wahab AA,Salem H,Yahmadi MA,Al Aisary S,Malviya M,ALhabsi A,Elsayed Y

doi

10.1007/s00431-020-03735-z

subject

Has Abstract

pub_date

2021-01-01 00:00:00

pages

195-200

issue

1

eissn

0340-6199

issn

1432-1076

pii

10.1007/s00431-020-03735-z

journal_volume

180

pub_type

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