Intraoperative Hypoxemic Spells in Tetralogy of Fallot An Echocardiographic Analysis of Diagnosis and Treatment

Greeley, William J.; Stanley, T. E.; Ungerleider, Ross M.; Kisslo, Joseph

doi:10.1213/00000539-198906000-00026

Cited by 10 publications

(6 citation statements)

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“…Using epicardial echocardiography with colour-flow imaging, Greeley et al 7 reported that, in a child with tetralogy of Fallot, the decrease in blood pressure induced a marked reduction in SaO 2 and a net right-to-left shunt through the ventricular septal defect, while phenylephrine 25 µg iv restored SaO 2 and a reversal of shunting with a net left-to-right ventricular shunt. However, we are unaware of any prospective study demonstrating the relationship between arterial blood pressure and PBF in tetralogy of Fallot.…”

Section: R Re Es Su Ul Lt Ts Smentioning

confidence: 99%

Phenylephrine increases pulmonary blood flow in children with tetralogy of Fallot

Tanaka

Kitahata

Kawahito

et al. 2003

Can J Anesth/J Can Anesth

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P Pu ur rp po os se e: : Although it has been reported that the increase in blood pressure improves arterial oxygen saturation (SaO 2 ) in children with tetralogy of Fallot, no prospective study has demonstrated that an increase in blood pressure induces an increase in pulmonary blood flow in these patients. The purpose of this study was to see whether a phenylephrine-induced increase in systemic blood pressure increased pulmonary blood flow, resulting in improved arterial oxygenation in tetralogy of Fallot.M Me et th ho od ds s: : In 14 consecutive children with tetralogy of Fallot (2-32 months old), transesophageal pulsed Doppler signals of left upper pulmonary venous flow (PVF) velocity were recorded before and four minutes after 10 µg·kg -1 of phenylephrine iv. Simultaneously, arterial blood gas analysis and hemodynamic measurements were performed. The minute distance (MD) was calculated as the product of the heart rate and the sum of time-velocity integrals of PVF.R Re es su ul lt ts s: : Phenylephrine iv increased mean arterial blood pressure from 54 ± 8 mmHg to 73 ± 10 mmHg. This phenylephrineinduced hypertension significantly increased SaO 2 and MD (92.0 ± 7.5 vs 95.0 ± 5.0% and 1318 ± 344 vs 1533 ± 425 cm·min -1 , respectively). There was a significant correlation (r = 0.72) between the change in MD and the change in SaO 2 .

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Section: R Re Es Su Ul Lt Ts Smentioning

confidence: 99%

Phenylephrine increases pulmonary blood flow in children with tetralogy of Fallot

Tanaka

Kitahata

Kawahito

et al. 2003

Can J Anesth/J Can Anesth

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“…The only physiologic event that has been successfully and convincingly demonstrated during a spell has been an increase in right-to-left shunting as seen on color Doppler flow imaging. 7 On termination of the spell, these workers documented left-to-right shunting. 7 These events can be explained entirely on the basis of alterations in systemic vascular resistance.…”

Section: Discussionmentioning

confidence: 99%

“…7 On termination of the spell, these workers documented left-to-right shunting. 7 These events can be explained entirely on the basis of alterations in systemic vascular resistance.…”

Section: Discussionmentioning

confidence: 99%

Hypercyanotic spells caused by antegrade catheterization of the pulmonary arteries in tetralogy of Fallot: fact or fiction?

et al. 1991

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SummaryBetween January 1985 and March 1990, 66 children with the tetralogy of Fallot underwent 85 cardiac catheterization procedures. The mean age at first procedure was 2.5 years (range 0.1–;14.4 years) and the mean weight was 10.4 kg ( range 2.4–36.0 kg). Diagnostic cardiac catheterization was performed in 60 procedures and balloon dilatation in 25. Hypercyanotic spells had occurred prior to 24 (28%) of the procedures (all the patients being on propranolol) and a systemic-to-pulmonary arterial shunt had been constructed before 28 (33%) procedures. Of the procedures, 54 (64%) were performed under local and 31(36%) under general anesthesia. The pulmonary trunk was entered antegradely in 52 procedures, retrogradely through a shunt in 6 and not entered in 27. Balloon dilatation was performed under general anesthesia on 25 occasions. No procedure was abandoned because of a cyanotic spell. Nine (11%) spells occurred during 86 procedures, one of the procedures being postponed because ofa spell occurring after premedication, the procedure and not, therefore, continuing to catheterization. Five spells occurred before the catheter was positioned in the heart, 2 spells occurred during catheterization. Of the spells, eight occurred during procedures in children who had not had previous shunts. Antegrade entry into the pulmonary trunk in the group with shunts was associated with no spells compared with 6/38 (18%) in the group not having undergone surgery (p<0.l). In the group not undergoing surgery, when the pulmonary trunk was not entered, 1 (5%) spell occurred during 19 procedures compared with 6/38 (18%) when the pulmonary trunk was entered (p<0.4). The only clinically important factor which significantly influenced the incidence of spells was the use of general anesthesia, which was associated with 6/31 (19%) spells compared with local anesthesia which was associated with 2/54 (4%) spells (p<0.026).

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“…25 Inotropic medications such as epinephrine may increase heart rate and increase dynamic RVOT obstruction and worsen the degree of cyanosis. 26 Despite optimal anesthetic management, these children are at risk for developing severe cyanosis during anesthesia and surgery, and the surgeon may need to expediently place the child on CPB.…”

Section: Anesthetic Concernsmentioning

confidence: 99%

Perioperative Management of DORV

Spaeth

2014

Semin Cardiothorac Vasc Anesth

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The diagnosis of double-outlet right ventricle (DORV) characterizes a complex heterogeneous group of congenital cardiac malformations for which multiple classification schemes have been used. A clear understanding of the anatomy is critical to understanding the physiologic consequences of the specific type of DORV. Perioperative considerations include the medical management of the patient during the preoperative period, anesthetic and surgical management, and postoperative care. Both anesthetic and surgical management strategies are very different depending on the type of DORV. Key principles for anesthetic management include balancing the systemic and pulmonary circulations, optimizing systemic cardiac output, and closely monitoring for impaired oxygen delivery to the tissues. Depending on the specific anatomy the patient is usually placed on a 1- or 2-ventricle pathway, and initial palliation may involve placement of a systemic arterial to pulmonary artery shunt or pulmonary artery banding. In some cases the child may undergo a complete repair during the first few months of life. Surgical outcomes, both short and long-term, are dependent on the type of DORV and surgical procedure done. These patients require long-term follow up and may present for surgical or catheter-based interventions as adults.

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Intraoperative Hypoxemic Spells in Tetralogy of Fallot An Echocardiographic Analysis of Diagnosis and Treatment

Cited by 10 publications

References 0 publications

Phenylephrine increases pulmonary blood flow in children with tetralogy of Fallot

Phenylephrine increases pulmonary blood flow in children with tetralogy of Fallot

Hypercyanotic spells caused by antegrade catheterization of the pulmonary arteries in tetralogy of Fallot: fact or fiction?

Perioperative Management of DORV

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