Zach Kelly J, Ramakrishna Harish, Chandrasekaran Krishnashwamy, Weis Ricardo A
Department of Anesthesia, Division of Cardiothoracic Anethesia, Mayo Clinic Hospital, Phoenix, AZ, USA.
Ann Card Anaesth. 2015 Apr-Jun;18(2):252-6. doi: 10.4103/0971-9784.154495.
Increasing numbers of adult patients with complex congenital heart conditions are presenting for noncardiac surgery later in life. These disorders can present challenges for surgical and anesthesia providers. Specifically, single ventricle lesions offer anatomic and physiologic concerns during the perioperative period. Single ventricle physiology represents a delicate balance between systemic and pulmonary blood flow. Any alterations in blood flow through these systems can produce undesirable hemodynamic changes, especially during the perioperative period. We present a case of an adult patient with a single left ventricle who presented for laparoscopic total colectomy due to inflammatory bowel disease. His abnormal anatomy coupled with the hemodynamic disruptions caused by laparoscopy presented significant anesthetic challenges. We highlight the anesthetic concerns of single ventricle physiology, specifically pertaining to laparoscopic surgery. We provide recommendations for safely managing these patients perioperatively. With detailed preoperative evaluation and close hemodynamic monitoring during the perioperative period, these patients can experience successful surgical and anesthetic outcomes.
越来越多患有复杂先天性心脏病的成年患者在晚年接受非心脏手术。这些疾病会给外科医生和麻醉医生带来挑战。具体而言，单心室病变在围手术期存在解剖和生理方面的问题。单心室生理状态代表着体循环和肺循环血流之间的微妙平衡。通过这些系统的血流的任何改变都可能产生不良的血流动力学变化，尤其是在围手术期。我们报告一例成年单左心室患者，因炎症性肠病接受腹腔镜全结肠切除术。他异常的解剖结构以及腹腔镜手术引起的血流动力学紊乱带来了重大的麻醉挑战。我们强调单心室生理状态的麻醉关注点，特别是与腹腔镜手术相关的。我们提供围手术期安全管理这些患者的建议。通过详细的术前评估和围手术期密切的血流动力学监测，这些患者可以获得成功的手术和麻醉结果。
