Management of right ventricular outflow tract reactivity following pulmonary valve dilatation under general anesthesia: experience of a medical mission.

During a recent volunteer medical mission to the Dominican Republic, we administered anesthesia to a child with severe pulmonary valvular stenosis and suprasystemic right ventricular pressure. This patient underwent a balloon pulmonary valvuloplasty but then developed worsening right ventricular outflow tract obstruction that required immediate therapy to prevent a low cardiac output state. As the development of hyperdynamic right ventricular outflow tract obstruction cannot be predicted, we emphasize the need for preemptive hydration and beta-blockade therapy prior to balloon dilatation.