[Anesthetic management for repair of Ebstein's anomaly with WPW syndrome].
Ebstein's anomaly is a rare congenital malformation of the tricuspid valve, often associated with Wolff-Parkinson-White (WPW) syndrome. We report the perioperative management of 3 patients (a 34-year-old man, a 5-month-old boy and a 5-year-old girl) with Ebstein's anomaly associated with WPW syndrome. Anesthetic managements for valvuloplasty of the tricuspid valve and ablation of accessory pathway in 3 patients were successfully accomplished with a combination of fentanyl, sevoflurane, and midazolam. The management of Ebstein's anomaly is based on its severity. The major concerns with anesthesia for children with Ebstein's anomaly include decreased cardiac output, right-to-left atrial level shunting with cyanosis, and the propensity for atrial tachyarrhythmias. We conclude that perioperative management of arrhythmia and evaluation of residual tricuspid regurgitation using transesophageal echocardiography are essential.
Department of Anesthesiology, Tokushima University Medical and Dental Hospital, Tokushima 770-8503.
Tomoka
T
Nakamura
Shinji
S
Kawahito
Hiroaki
H
Kawano
Tsuyoshi
T
Okada
Hiroshi
H
Kitahata
Shuzo
S
Oshita
D000328:Adult; D000758:Anesthesia; D001145:Arrhythmias, Cardiac / Q000628:therapy; D002675:Child, Preschool; D004437:Ebstein Anomaly / Q000150:complications* / Q000601:surgery*; D017548:Echocardiography, Transesophageal; D005260:Female; D005283:Fentanyl; D006801:Humans; D007223:Infant; D008297:Male; D008738:Methyl Ethers; D008874:Midazolam; D019990:Perioperative Care; D011183:Postoperative Complications / Q000628:therapy; D000077149:Sevoflurane; D014261:Tricuspid Valve / Q000601:surgery; D014262:Tricuspid Valve Insufficiency / Q000000981:diagnostic imaging; D014927:Wolff-Parkinson-White Syndrome / Q000150:complications* / Q000601:surgery*
D008738:Methyl Ethers; D000077149:Sevoflurane; D008874:Midazolam; D005283:Fentanyl