Flow acceleration and dynamic left ventricular outflow tract obstruction in neonatal warm shock: Echocardiographic phenotyping and management implications

IF 0.4 Q4 PEDIATRICS

PROGRESS IN PEDIATRIC CARDIOLOGY Pub Date : 2026-03-01 Epub Date: 2026-01-30 DOI:10.1016/j.ppedcard.2026.101908

Benjamim Ficial , Beatrice Allena , Ilaria Boffa , Arianna Zuccato , Daniele Mosolo , Martina Ciarcià , Federica Runfola , Silvia Nogara , Iuri Corsini , Willem P. de Boode

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引用次数: 0

Abstract

Echocardiography is increasingly used to assess hemodynamics in critically ill neonates. We describe a novel echocardiographic phenotype associated with warm shock in preterm neonates with late-onset sepsis, ranging from left ventricular outflow tract (LVOT) acceleration to dynamic LVOT obstruction, with systolic anterior motion (SAM) of the mitral valve and secondary mitral regurgitation (MR).

We retrospectively reviewed six consecutive preterm neonates with late-onset sepsis admitted between June 2024 and June 2025. All underwent neonatologist performed echocardiography (NPE) at the time of clinical deterioration.

All neonates presented with signs of warm shock, including tachycardia and hyperdynamic circulation. NPE demonstrated aliasing across the LVOT on color Doppler and a dagger-shaped spectral Doppler profile, indicative of LVOT acceleration. In three cases, dynamic LVOT obstruction with SAM and MR was demonstrated. Management included fluid boluses and vasopressors (norepinephrine); two cases required β-blockade (esmolol), resulting in resolution of obstruction and MR.

This case series describes a previously unreported echocardiographic phenotype associated with warm shock in preterm neonates, characterized by a spectrum ranging from LVOT flow acceleration to dynamic LVOT obstruction with SAM and secondary MR. NPE enabled early identification and pathophysiological understanding, and tailored management. Prospective studies are needed to validate these findings.

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新生儿热休克的血流加速和动态左心室流出道阻塞：超声心动图表型和管理意义

超声心动图越来越多地用于评估危重新生儿的血液动力学。我们描述了一种与迟发性败血症早产儿热休克相关的新型超声心动图表型，其范围从左心室流出道（LVOT）加速到动态LVOT阻塞，伴有二尖瓣收缩前运动（SAM）和继发性二尖瓣反流（MR）。我们回顾性分析了2024年6月至2025年6月期间连续入院的6例迟发性脓毒症早产儿。所有患者均在临床恶化时接受了新生儿超声心动图检查。所有新生儿均有热休克症状，包括心动过速和高动力循环。NPE在彩色多普勒和匕首形多普勒光谱上显示了LVOT上的混叠，表明LVOT加速。在三个病例中，SAM和MR显示了动态LVOT阻塞。治疗包括液体丸和血管加压剂（去甲肾上腺素）；两个病例需要β-阻断剂（艾司洛尔），导致梗阻和mr的解决。该病例系列描述了一种以前未报道的与早产儿热休克相关的超声心动图表型，其特征范围从LVOT血流加速到动态LVOT梗阻，伴有SAM和继发性mr。NPE能够早期识别和病理生理理解，并进行针对性的管理。需要前瞻性研究来验证这些发现。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

PROGRESS IN PEDIATRIC CARDIOLOGY PEDIATRICS-

CiteScore

0.90

自引率

11.10%

发文量

审稿时长

75 days

期刊介绍： Progress in Pediatric Cardiology is an international journal of review presenting information and experienced opinion of importance in the understanding and management of cardiovascular diseases in children. Each issue is prepared by one or more Guest Editors and reviews a single subject, allowing for comprehensive presentations of complex, multifaceted or rapidly changing topics of clinical and investigative interest.