Anesthesia for Blalock-Taussig shunt and pacemaker placement in an adult patient with univentricular heart. Case report.
OBJECTIVE
Univentricular heart is a complex, rare, and severe cardiopathy, with no possibility of curative surgical treatment, associated with a high mortality in the first years of life. The objective of this article was to describe a rare case of an adult patient with uncorrected single ventricle who was admitted for pulmonary valvuloplasty but was submitted to a modified Blalock-Taussig and placement of an epicardic pacemaker. The complementary objective of this report was to address the anesthetic particularities of adult patients with uncorrected congenital cardiopathy. CASE REPORT A 34 years old female patient, weighing 60 kg, with a complex congenital cardiopathy with a single ventricle, important infundibular pulmonary stenosis and moderate pulmonary hypertension was admitted to the hospital without conditions to undergo surgical correction. The patient had a history several therapeutic bleedings to treat polycythemia. She was admitted due to worsening hypoxemia, an episode of syncope, and recent onset of third degree atrioventricular block. On admission, the patient was hemodynamically stable, heart rate of 42 bpm, SpO2 73%, central cyanosis and cyanosis of the extremities, and blood pressure 120 x 70 mmHg. Cardiac catheterization and pulmonary valvuloplasty were proposed. Due to the impossibility of success of this technique, Blalock-Taussig procedure with placement of a pacemaker was indicated. The procedure was performed in the following day without intercurrences, and the patient was discharged 7 days after the surgery, with SpO2 85%, hematocrit 49%, and improvement of the dyspnea.


CONCLUSIONS
The success of anesthesia for surgical correction of complex congenital cardiopathy requires knowledge on the pathophysiology of the disorder, as well as the particularities inherent to the anesthetic technique used.
Hospital Biocor, Nova Lima, MG. mnacur@yahoo.com.br
Michelle Nacur
MN
Lorentz
Raquel Reis
RR
Soares
Cláudia Vargas Araújo
CV
Ribeiro
Friederike Wolff
FW
Valadares
D000328:Adult; D000758:Anesthesia; D001011:Aorta / Q000601:surgery*; D006348:Cardiac Surgical Procedures / Q000379:methods; D005260:Female; D006330:Heart Defects, Congenital / Q000601:surgery*; D006801:Humans; D010138:Pacemaker, Artificial; D011651:Pulmonary Artery / Q000601:surgery*; D014656:Vascular Surgical Procedures / Q000379:methods