[Anesthetic management in a patient complicated with left coronary artery-left ventricular fistulae].
We have experienced anesthetic management for posterior lumbar interbody fusion in a 76-year-old female with left coronary artery-left ventricular fistulae. She was admitted to our hospital because of chest pain and was found to have left coronary artery-left ventricular fistulae 6 months before this operation. The electrocardiogram at rest showed T-wave inversions in leads V3-V6. Selective coronary angiography showed the contrast medium streaming into the left ventricle via a maze of fine vessels from the distal left anterior descending coronary artery. Cardiac catheterization revealed left ventricular end-diastolic pressure of 30 mmHg and mean pulmonary capillary wedge pressure of 16 mmHg. Anesthesia was induced with intravenous propofol 60 mmHg, fentanyl 0.1 mg and vecuronium 6 mg, and maintained with 50% nitrous oxide and isoflurane (0.5-1.5%) in oxygen with meticulous intravenous administration of fentanyl. Cardiac function was evaluated with Swan-Ganz catheter during anesthesia. Dopamine and prostaglandin E1 ware continuously infused intravenously to decrease high afterload and maintain cardiac output. The operative and post-operative courses were uneventful. Coronary artery-left ventricular fistulae are extremely rare and can cause myocardial ischemia from coronary steal. A careful management with meticulous anesthetic care is emphasized for patients with coronary artery-left ventricular fistulae.
Suzuki
Satomi
S
Department of Anesthesiology, Yamanashi Medical University, Yamanashi 409-3898.
Nonaka
Akihiko
A
Masamune
Taishi
T
Kumazawa
Teruo
T
D000368:Aged; D000758:Anesthesia; D003330:Coronary Vessel Anomalies / Q000150:complications*; D005260:Female; D005402:Fistula / Q000150:complications*; D006352:Heart Ventricles / Q000002:abnormalities*; D006801:Humans; D008159:Lumbar Vertebrae / Q000601:surgery; D019990:Perioperative Care; D013123:Spinal Fusion; D013130:Spinal Stenosis / Q000150:complications / Q000601:surgery; D016157:Vascular Fistula / Q000150:complications*