Case Report
Management of Functional Pulmonary Atresia with Isoproterenol in a Neonate with Ebstein's Anomaly
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HIROSHI SUZUKI, MITSURU NAKASATO, SATOSHI SATO, HIROKI KOMATSU, and KIYOSHI HAYASAKA
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Department of Pediatrics, Yamagata University School of Medicine, Yamagata 990-23
Ebstein's anomaly is a rare congenital cardiac anomaly showing significant clinical manifestations with a high mortality rate in the neonatal period. The prognosis of the patient is essentially determined by the severity in morphological changes, however, high pulmonary vascular resistance in the neonatal period may aggravate tricuspid regurgitation and lead to functional pulmonary atresia. We describe a critically ill neonate with morphologically mild Ebstein's anomaly who was successfully managed with intensive care including isoproterenol administration for functional pulmonary atresia. Isoproterenol is a potent pulmonary vasodilator with inotropic and chronotropic effects, and seemed to decrease the pulmonary vascular resistance allowing increased antegrade blood flow to the pulmonary artery and improved cardiac output. If tachycardia is not present, isoproterenol administration is recommended in critically ill neonates with anatomically mild Ebstein's anomaly and no associated cardiac defects.
Key words---
isoproterenol; functional pulmonary atresia; Ebstein's anomaly; management
Tohoku J. Exp. Med., 1997, 181, 459-465
Address for reprints:
Hiroshi Suzuki, M.D., Department of Pediatrics, Yamagata University School of Medicine, 2-2-2 Iida-nishi, Yamagata 990-23, Japan.
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