[Anesthetic experience in a case of an adolescent with severe pulmonary hypertension associated with ventricular septal defect].
A 14-year-old girl with severe pulmonary hypertension (PH) associated with ventricular septal defect was scheduled for intracardiac repair surgery. Preoperative pulmonary arterial pressure (PAP) was 85/47 mmHg, and the pulmonary vascular resistance was 8.2 unit.m-2. After the induction of general anesthesia, PAP (75/31 mmHg) remained unchanged and eventually exceeded arterial pressure (AP, 70/30 mmHg). Neither pulmonary vasodilatation therapy with the inspiration of high oxygen concentration nor intravenous administration of vasodilators (ATP or prostaglandin-I2) could decrease the PAP, but resulted in the exacerbation of systemic arterial hypotension. Accordingly, we cancelled the cardiac surgery considering the possibility of lethal postoperative pulmonary hypertension. Eleven days later, lung biopsy under one-lung ventilation anesthesia was performed. During the one-lung ventilation anesthesia, we applied PEEP with 100% of oxygen onto the independent lung in order to avoid pulmonary vasoconstriction. Although mild hypoxemia (SpO2 = 93%) and transient elevation in PAP to 130/80 mmHg (equal to AP) were observed, the biopsy was completed without any major problems. A histological examination revealed pulmonary plexogenic arteriopathy, the complete contraindication to cardiac surgery. In the anesthetic management of adolescent cases with PH, we should consider the existence of extremely severe pulmonary arterial obstructive changes not diagnosed by preoperative hemodynamic evaluations. Careful monitoring of pulmonary hemodynamics and the application of strategies to avoid lethal PH should be considered.
Ito
Reiko
R
Departments of Anesthesiology and Intensive Care, Third Department of Internal Medicine, Kyoto Prefectural University of Medicine, Kyoto 602-8566.
Shime
Nobuaki
N
Yamazaki
Yasuo
Y
Toiyama
Kentaro
K
Tanaka
Yoshifumi
Y
D000293:Adolescent; D000768:Anesthesia, General; D001157:Arterial Occlusive Diseases / Q000473:pathology; D001706:Biopsy; D006348:Cardiac Surgical Procedures; D000075202:Contraindications; D005260:Female; D006345:Heart Septal Defects, Ventricular / Q000150:complications* / Q000601:surgery; D006801:Humans; D006976:Hypertension, Pulmonary / Q000209:etiology* / Q000473:pathology; D008168:Lung / Q000098:blood supply; D012121:Respiration, Artificial / Q000379:methods; D012720:Severity of Illness Index; D013906:Thoracoscopy