Anesthetic management of bidirectional cavopulmonary shunt in a patient with pulmonary atresia with intact ventricular septum associated with sinusoidal communications

Yoshitaka Kawaraguchi, Akihiro Taniguchi, Tomoko Otomo, Chiharu Ota, Naoko Uchida

Research output: Contribution to journalArticlepeer-review

4 Citations (Scopus)

Abstract

Pulmonary atresia with intact ventricular septum (PAIVS) is sometimes associated with coronary artery anomalies, including right ventricle (RV)-to-coronary artery fistulas (sinusoidal communications), coronary artery stenoses, and coronary artery occlusions. In some cases, the coronary circulation depends entirely or partly on the desaturated systemic venous blood supply from the RV. Under these circumstances, decompression of the RV can result in fatal myocardial ischemia. A 6-month-old boy, diagnosed with PAIVS associated with sinusoidal communications, underwent a bidirectional cavopulmonary shunt procedure under venoarterial cardiopulmonary bypass (CPB). During CPB, to prevent RV decompression, we maintained right atrial pressure above 5mmHg and used a pump perfusion rate of 30%-40% of the calculated value based on body surface area. Although electrocardiography showed slight ST depression and bradycardia, myocardial contractility after weaning from CPB was adequate to maintain the circulation with the administration of dobutamine and atrial pacing. In patients with PAIVS and RV-dependent coronary circulation, it is important to maintain coronary artery perfusion throughout the period of anesthesia.

Original languageEnglish
Pages (from-to)220-222
Number of pages3
JournalJournal of Anesthesia
Volume20
Issue number3
DOIs
Publication statusPublished - 2006 Aug 1
Externally publishedYes

Keywords

  • Anesthesia
  • Bidirectional cavopulmonary shunt
  • Pulmonary atresia with intact ventricular septum
  • Sinusoidal communication

ASJC Scopus subject areas

  • Anesthesiology and Pain Medicine

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