Pulmonary atresia with ventricular septal defect: a case for central venous pressure and oxygen saturation monitoring.
A 21-year-old patient with pulmonary atresia and ventricular septal defect (PA-VSD) was admitted to the hospital for tubal ligation. Invasive arterial and central venous (CVP) pressure, pulse oximetric oxygen saturation (SpO2), and (from the tip of oximetric central venous catheter) central venous oxygen saturation (ScvO2) and oxygen extraction rate (ExO2) were continuously monitored. Heart rate (range: 68-75 beat/min), mean arterial pressure (80-90 mmHg), CVP (7-10 mmHg), SpO2 (79-90 percent), ScvO2 (57-70 percent), and ExO2 (21-30 percent) remained stable during epidural anesthesia and transvaginal sterilization. Following an overnight stay (peak SpO2 92 percent; peak ScvO2 71 percent; through ExO2 21 percent), the oxygen data returned to baseline on awakening (SpO2 < 80 percent, ScvO2 < 55 percent, ExO2 > 35 percent), and the patient was discharged. In PA-VSD, a single-outlet double-ventricle anomaly, CVP reflects the preload of systemic ventricle. As the mixed venous oxygen saturation cannot be defined, ScvO2 is the best available indicator of the whole body oxygen consumption. Continuous monitoring of CVP, ScvO2 and ExO2 in the superior vena cava may provide more insight into the response to anesthesia and surgery in patients with PA-VSD.
Department of Anesthesiology, University Hospital, Zurich, Switzerland.
B M
BM
Weiss
P G
PG
Atanassoff
R
R
Jenni
B
B
Walder
E
E
Wight
D000015:Abnormalities, Multiple; D000328:Adult; D000767:Anesthesia, Epidural; D002496:Central Venous Pressure; D004562:Electrocardiography; D005260:Female; D006345:Heart Septal Defects, Ventricular / Q000503:physiopathology*; D006439:Hemodynamics; D006801:Humans; D007432:Intraoperative Period; D008991:Monitoring, Physiologic; D010092:Oximetry; D011182:Postoperative Care; D018633:Pulmonary Atresia / Q000503:physiopathology*; D013246:Sterilization, Tubal / Q000379:methods*