Watabe Akira, Saito Hitoshi, Harasawa Katsumi, Morimoto Yuji
Department of Anesthesiology and Critical Care Medicine, Hokkaido University Graduate School of Medicine, N15 W7, Kita-ku, Sapporo, 060-8638, Japan.
J Anesth. 2009;23(2):270-4. doi: 10.1007/s00540-008-0718-z. Epub 2009 May 15.
We report the anesthetic management of a 7-month-old male infant with severe aortic regurgitation (AR) scheduled for the Ross procedure. To the best of our knowledge, this is the first report from the viewpoint of anesthetic management for the Ross procedure performed in an infant. He had been suffering from severe AR that occurred suddenly when he was 5 months old. The cause of the AR was considered to be spontaneous rupture of a fenestrated aortic valve, owing to congenital tissue defect in part of the aortic valvular leaflet. The Ross procedure was scheduled to be performed under general anesthesia using deep hypothermic cardiopulmonary bypass (CPB). Continuous infusion of nitroglycerin was started during CPB and continued after CPB to dilate the newly implanted coronary arteries for the prevention of myocardial ischemia and to decrease afterload and pulmonary vascular resistance. Weaning from CPB was performed without difficulty, but after the prolonged CPB he had a bleeding tendency that needed transfusion and a hemostatic drug. Monitoring with transesophageal echocardiography was very useful for evaluating myocardial ischemia, and for assessing the procedure and the completion of surgical repair. His postoperative course was uneventful and he was discharged on the 25th postoperative day.
我们报告了一名计划接受罗斯手术的7个月大重度主动脉瓣反流（AR）男婴的麻醉管理情况。据我们所知，这是从婴儿罗斯手术麻醉管理角度的首份报告。他自5个月大时起就患有突然出现的重度AR。AR的病因被认为是由于主动脉瓣小叶部分存在先天性组织缺陷，导致有孔主动脉瓣自发破裂。罗斯手术计划在全身麻醉下使用深低温体外循环（CPB）进行。CPB期间开始持续输注硝酸甘油，并在CPB后继续输注，以扩张新植入的冠状动脉，预防心肌缺血，并降低后负荷和肺血管阻力。CPB脱机过程顺利，但在长时间CPB后，他出现了出血倾向，需要输血和使用止血药物。经食管超声心动图监测对于评估心肌缺血、评估手术过程及手术修复完成情况非常有用。他的术后病程平稳，术后第25天出院。
