Cosgrove Marianne S
Hospital of St. Raphael School of Nurse Anesthesia, New Haven, Connecticut, USA.
AANA J. 2012 Jun;80(3):197-203.
Adult congenital heart disease, previously considered a rare comorbidity, is increasingly becoming a reality for today's anesthesia providers. Improvements in prenatal diagnosis, sophisticated surgical techniques and equipment, advances in pediatric critical care, enhanced efficacy of cardiovascular pharmacologic agents, and an overall increase in postrepair survival rates have resulted in an estimated population of approximately 800,000 adults with congenital heart disease. Despite successful surgical repair or palliation, these individuals present the anesthesia provider with a multitude of challenges. Individualized care of these fragile patients should be approached with a keen understanding of the patient's underlying cardiac anomaly. This case report chronicles the anesthetic care of a 36-year-old woman presenting for left-sided ureteroscopy with laser lithotripsy and stent placement. Her medical history was remarkable for the presence of complex congenital heart disease consisting of multiple anomalies: a double-outlet right ventricle, transposition of the great arteries, pulmonary stenosis, atrial septal defect, and a hypoplastic left ventricle with concomitant mitral valve atresia. General anesthesia was successfully administered, with meticulous attention given to maintenance of systemic vascular resistance to minimize shunting, oxygenation, administration of preprocedure antibiotics, and judicious replacement of intravenous fluids via air-filtered tubing.
成人先天性心脏病，以前被认为是一种罕见的合并症，如今对于麻醉医生来说正日益成为现实。产前诊断的改善、先进的外科技术和设备、小儿重症监护的进步、心血管药物疗效的提高以及修复后生存率的总体上升，导致目前估计有近80万患有先天性心脏病的成年人。尽管手术修复或姑息治疗取得了成功，但这些患者给麻醉医生带来了诸多挑战。对于这些脆弱患者的个体化护理，需要深入了解患者潜在的心脏异常情况。本病例报告记录了一名36岁女性接受左侧输尿管镜激光碎石术和支架置入术的麻醉护理过程。她有复杂先天性心脏病的病史，包括多种异常：右心室双出口、大动脉转位、肺动脉狭窄、房间隔缺损以及伴有二尖瓣闭锁的左心室发育不全。成功实施了全身麻醉，同时精心维持体循环血管阻力以尽量减少分流、维持氧合、术前给予抗生素，并通过空气过滤管谨慎补充静脉液体。
