Toda Y, Takeuchi M, Morita K, Oe K, Iwasaki T, Taga N, Kosaka M, Hirakawa M
Department of Anesthesiology and Resuscitology, Okayama University Medical School, Okayama 700-8558.
Masui. 2000 Nov;49(11):1231-4.
We report perioperative management of 4 patients with anomalous origin of the left coronary artery from the pulmonary artery. This report involves with 3 infant cases and an adult. Two infants underwent coronary reimplantation procedure and Takeuchi's method was performed on the other infant. In all infant cases, mitral valve plasty was performed to correct mitral regurgitation secondary to papillary muscle dysfunction. The adult patient underwent CABG with ligation of LCA. General anesthesia was performed with high doses of fentanyl in all cases. We employed a relatively high PaCO2 and low FIO2 in order to maintain a high pulmonary vascular resistance. It aims to decrease the incidence of left to right shunt. We used epinephrine to wean one infant and the adult from cardiopulmonary bypass. Perioperative course was uneventful with the use of catecholamines and high doses of vasodilators for left ventricular dysfunction and coronary perfusion under mechanical ventilation.
我们报告了4例左冠状动脉起源于肺动脉患者的围手术期管理情况。本报告涉及3例婴儿病例和1例成人病例。2例婴儿接受了冠状动脉再植入手术，另1例婴儿采用了竹内氏手术方法。在所有婴儿病例中，均进行了二尖瓣成形术以纠正继发于乳头肌功能障碍的二尖瓣反流。成年患者接受了冠状动脉旁路移植术并结扎了左冠状动脉。所有病例均采用高剂量芬太尼进行全身麻醉。为维持较高的肺血管阻力，我们采用了相对较高的动脉血二氧化碳分压和较低的吸入氧分数。目的是降低左向右分流的发生率。我们使用肾上腺素使1例婴儿和成年患者脱离体外循环。在机械通气下，使用儿茶酚胺和高剂量血管扩张剂治疗左心室功能障碍并进行冠状动脉灌注，围手术期过程顺利。
