Anaesthetic Challenges and Transesophageal Echocardiography-Guided Perioperative Management in a Patient with Uncorrected Adult Congenital Heart Disease Presenting for Emergency Laparoscopic Hysterectomy

Abstract

Anaesthetic management of a patient with adult congenital heart disease with a single ventricle physiology presenting for an emergency laparoscopic surgery is challenging. The importance of a multidisciplinary approach, astute understanding of the pathophysiology and optimisation of intraoperative hemodynamic goals cannot be overemphasised. The present report describes the anaesthetic challenges and the role of transoesophageal echocardiography in perioperative management of a patient with uncorrected tetralogy of Fallot with pulmonary atresia, who successfully underwent an emergency laparoscopic hysterectomy under general anaesthesia.

Anesthesia management of laparoscopic right colectomy in an older patient with postoperative tetralogy of Fallot with residual anomaly

“…The increasing intrathoracic pressure caused by mechanical ventilation and insufflation decreased the left-to-right shunt volume, bringing Qp/Qs close to 1.0. However, laparoscopic hysterectomy in adult patients with TOF and residual pulmonary atresia has been reported to increase intrathoracic pressure caused by pneumoperitoneum-induced right-to-left shunting and cyanosis with compromised pulmonary blood flow [ 6 ]. Anesthesia and surgical manipulation can alter the balance between systemic and pulmonary vascular resistance, potentially reversing the shunt.…”

“…Intraoperative TEE is useful in treating ACHD. A successful case of laparoscopic total hysterectomy in a patient with TOF and unrepaired pulmonary atresia has been reported [ 6 ], in which qualitative evaluation of the left ventricular end-diastolic volume using TEE was used as a surrogate index of left ventricular preload to prevent excessive infusion [ 6 , 7 ]. It also described the advantages of TEE in terms of ventricular function over time and air embolism monitoring.…”