Brazilian Journal of Anesthesiology
https://app.periodikos.com.br/journal/rba/article/doi/10.1590/S0034-70942008000300007
Brazilian Journal of Anesthesiology
Clinical Information

Anestesia para correção cirúrgica de blalock-taussig e implante de marca-passo em adulto portador de ventrículo único: relato de caso

Anesthesia for blalock-taussig shunt and pacemaker placement in an adult patient with univentricular heart: case report

Michelle Nacur Lorentz; Raquel Reis Soares; Cláudia Vargas Araújo Ribeiro; Friederike Wolff Valadares

http://dx.doi.org/10.1590/S0034-70942008000300007 Braz J Anesthesiol, vol.58, n3, p.246-251, 2008
PDF Português
PDF English
Downloads: 0
Views: 1441

Resumo

JUSTIFICATIVA E OBJETIVOS: O ventrículo único é uma cardiopatia complexa rara e grave, sem possibilidade de tratamento cirúrgico curativo, associada à alta mortalidade durante a primeira infância. O objetivo desse artigo foi descrever um caso raro de paciente adulto com ventrículo único não-operado que se internou para realização de valvoplastia pulmonar via hemodinâmica e acabou sendo submetido à cirurgia de Blalock-Taussig modificado e implante de marca-passo epicárdico. Teve como objetivo complementar chamar a atenção para as particularidades anestésicas do paciente adulto portador de cardiopatia congênita não-corrigida. RELATO DO CASO: Paciente de 34 anos, 60 kg, portadora de cardiopatia congênita complexa tipo ventrículo único, estenose infundibulovalvar pulmonar importante e hipertensão pulmonar moderada. Admitida no hospital sem condições de correção cirúrgica e com história pregressa de várias sangrias terapêuticas para tratamento de policitemia. Foi internada devido a piora da hipoxemia, um episódio de síncope e bloqueio atrioventricular total (BAVT) de início recente. À internação apresentava estabilidade hemodinâmica, freqüência cardíaca de 42 bpm, SpO2 de 73%, cianose central e de extremidades e pressão arterial de 120 × 70 mmHg. Foi proposta a realização de cateterismo e valvoplastia pulmonar via hemodinâmica. Por causa da impossibilidade de realização dessa técnica com sucesso, foi indicada a realização de cirurgia de Blalock-Taussig com implante de marca-passo. O procedimento foi realizado no dia seguinte sem intercorrências e a paciente teve alta hospitalar sete dias após o procedimento cirúrgico com SpO2 de 85%, hematócrito de 49% e melhora da dispnéia. CONCLUSÕES: O sucesso do procedimento anestésico para correção cirúrgica de cardiopatia congênita complexa demanda conhecimento da fisiopatologia da doença, bem como das particularidades inerentes à técnica anestésica utilizada.

Palavras-chave

CIRURGIA, Cardíaca, CIRURGIA, Cardíaca, DOENÇAS, Congênita

Abstract

BACKGROUND AND OBJECTIVES: Univentricular heart is a complex, rare, and severe cardiopathy, with no possibility of curative surgical treatment, associated with a high mortality in the first years of life. The objective of this article was to describe a rare case of an adult patient with uncorrected single ventricle who was admitted for pulmonary valvuloplasty but was submitted to a modified Blalock-Taussig and placement of an epicardic pacemaker. The complementary objective of this report was to address the anesthetic particularities of adult patients with uncorrected congenital cardiopathy. CASE REPORT: A 34 years old female patient, weighing 60 kg, with a complex congenital cardiopathy with a single ventricle, important infundibular pulmonary stenosis and moderate pulmonary hypertension was admitted to the hospital without conditions to undergo surgical correction. The patient had a history several therapeutic bleedings to treat polycythemia. She was admitted due to worsening hypoxemia, an episode of syncope, and recent onset of third degree atrioventricular block. On admission, the patient was hemodynamically stable, heart rate of 42 bpm, SpO2 73%, central cyanosis and cyanosis of the extremities, and blood pressure 120 × 70 mmHg. Cardiac catheterization and pulmonary valvuloplasty were proposed. Due to the impossibility of success of this technique, Blalock-Taussig procedure with placement of a pacemaker was indicated. The procedure was performed in the following day without intercurrences, and the patient was discharged 7 days after the surgery, with SpO2 85%, hematocrit 49%, and improvement of the dyspnea. CONCLUSIONS: The success of anesthesia for surgical correction of complex congenital cardiopathy requires knowledge on the pathophysiology of the disorder, as well as the particularities inherent to the anesthetic technique used.

Keywords

DISEASES, congenital, SURGERY, Cardiac, SURGERY, Cardiac

References

Restaino G, Dirksen MS, de Roos A. Long-term survival in a case of unoperated single ventricle. Int J Cardiovasc Imaging. 2004;20:221-225.

Ammash NM, Warnes CA. Survival in adulthood of patients with unoperated single ventricle. Am J Cardiol. 1996;77:542-544.

Latin-Hermoso MR. Pediatric cardiology for the primary care pediatrician. Indian J Pediatr. 2005;72:513- 518.

Cabrera A, Fernández J, Alcibar J. Ventrículo único de morfologia izquierda corregido a los 49 años com buena evolución. Rev Esp Cardiol. 2000;53:1140-1143.

Nelson DP, Schwartz SM, Chang AC. Neonatal physiology of the functionally univentricular heart. Cardiol Young. 2004;14(^s1):52- 60.

Heggie J, Poirer N, Williams W. Anesthetic considerations for the adult cardiac surgery patients with congenital heart disease. Semin Cardiothorac Vasc Anesth. 2003;7:141-153.

Tweddell JS, Hoffman GM, Mussatto KA. Improved survival of patients undergoing palliation of hypoplasic left heart syndrome: lessons learned from 115 consecutive patients. Circulation. 2002;106:I82-I89.

Jobes DR, Nicolson SC, Steven JM. Carbon dioxide prevents pulmonary over circulation in hipoplastic left heart syndrome. Ann Thorac Surg. 1992;54:150-151.

Keidan I, Mishaly D, Berkenstadt H. Combining low inspired oxygen and carbon dioxide during mechanical ventilation for the Norwood procedure. Paediatric Anaesth. 2003;13:58-62.

Hoffman GM, Tweddell JS, Ghanayem NS. Alteration of the critical arteriovenous oxygen saturation relationship by sustained afterload reduction after the Norwood procedure. J Thorac Cardiovasc Surg. 2004;127:738-745.

Hoffman GM, Ghanayem NS, Kampine JM. Venous saturation and the anaerobic threshold in neonates after the Norwood procedure for hypoplastic left heart syndrome. Ann Thorac Surg. 2000;70:1515-1521.

5dd6b1bb0e88257e5e13f287 rba Articles
Links & Downloads
2352-2291 (Electronic) 0104-0014 (Printed)
Braz J Anesthesiol ©2024 All rights reserved.

Braz J Anesthesiol

Share this page
Page Sections