老年法洛四联症术后残留异常患者行腹腔镜右半结肠切除术的麻醉管理
Anesthesia management of laparoscopic right colectomy in an older patient with postoperative tetralogy of Fallot with residual anomaly.
作者信息
Mori Satori, Ito Hisakatsu, Sugimoto Sadamu, Hibi Daisuke, Kameyama Akiyo, Kawakami Masaaki, Takazawa Tomonori
机构信息
Department of Anesthesiology, University of Toyama, Sugitani 2630, Toyama, Toyama, 930-0194, Japan.
Department of Anesthesiology, Kurobe City Hospital, Mikkaiti 1108-1, Kurobe, Toyama, 938-8502, Japan.
出版信息
JA Clin Rep. 2024 Apr 11;10(1):24. doi: 10.1186/s40981-024-00707-2.
BACKGROUND
Diversity in hemodynamics of adult congenital heart disease necessitates a case-by-case selection of appropriate surgical and anesthetic options. However, previous case reports regarding the management of laparoscopic surgery in adult patients with congenital heart disease are limited.
CASE PRESENTATION
A 72-year-old man who underwent a laparoscopic right colectomy for colon cancer had a residual ventricular septal defect and right ventricular outflow tract obstruction despite post-repair of tetralogy of Fallot. Pulmonary hypertension or right ventricular dysfunction was not observed. The preoperative pulmonary to systemic blood flow ratio (Qp/Qs) was 2.3. After positive pressure ventilation and insufflation, the amount of left-to-right ventricular shunting decreased, and the Qp/Qs approached 1.0, as calculated from pulmonary arterial and systemic arterial blood gas analysis.
CONCLUSIONS
Laparoscopic surgery might be tolerable in patients with tetralogy of Fallot who have preserved the right ventricular function, left-to-right ventricular shunting, and no high pulmonary vascular resistance.
背景
成人先天性心脏病血流动力学的多样性使得必须针对具体病例选择合适的手术和麻醉方案。然而，以往关于成人先天性心脏病患者腹腔镜手术管理的病例报告有限。
病例介绍
一名72岁男性因结肠癌接受了腹腔镜右半结肠切除术，尽管法洛四联症修复术后仍存在室间隔缺损和右心室流出道梗阻。未观察到肺动脉高压或右心室功能障碍。术前肺循环与体循环血流量之比（Qp/Qs）为2.3。正压通气和充气后，左向右心室分流减少，根据肺动脉和体动脉血气分析计算，Qp/Qs接近1.0。
结论
对于右心室功能保留、存在左向右心室分流且无高肺血管阻力的法洛四联症患者，腹腔镜手术可能是可以耐受的。
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