title: Anesthesia for pacemaker implant in an adult patient with unoperated univentricular heart. Case report.
abstract: OBJECTIVE
  Single ventricle is a rare abnormality, affecting 1% of the patients with congenital cardiopathy. Only 11 cases of patients with unoperated univentricular heart older than 50 years were reported in the literature. The aim of this report was to describe the anesthetic conduct in a patient with univentricular heart undergoing pacemaker implant.
  
  
  METHODS
  A female patient, 47 years old, with double outlet left ventricle, L-transposition of the great vessels, and pulmonary stenosis, without prior surgical correction, was scheduled for definitive implant of a sequential dual-chamber pacemaker. The ABPM demonstrated second degree atrioventricular block and a mean heart rate of 45 bpm. Preoperative exams showed a hematocrit of 57%, normal coagulation studies, and preserved ventricular function. Monitoring consisted of pulse oxymeter, ECG on D(II) and V5, IBP, capnograph, and gas analyzer. A temporary transcutaneous pacemaker was available in case of severe bradycardia. Anesthesia was induced with fentanyl (0.25 mg), etomidate (20 mg), and atracurium (35 mg). Four minutes after anesthetic induction, the heart rate decreased to 30 bmp and 1 mg of atropine was administered with reversal of the bradycardia. Anesthesia was maintained with 2.5% sevoflurane, 60% room air, and 40% oxygen. Hemodynamic parameters and oxygen saturation remained stable. The patient was transferred to the intensive care unit in stable condition and extubated at the end of the procedure.
  
  
  CONCLUSIONS
  The anesthetic conduct for pacemaker implant in a 47-year old patient with non-operated double outlet left ventricle and pulmonary stenosis was appropriate, since it allowed the procedure to be performed.
authors.affiliation: Santa Casa de Belo Horizonte, Belo Horizonte, MG. hobaika@globo.com
authors.forename: Adriano Bechara de Souza
authors.initials: AB
authors.lastname: Hobaika
authors.forename: André Luís Pontes
authors.initials: AL
authors.lastname: Procópio
authors.forename: Marcelo Luiz Souza
authors.initials: ML
authors.lastname: Pereira
authors.forename: Aristóteles Pereira
authors.initials: AP
authors.lastname: Coimbra
authors.forename: Magda Lourenço
authors.initials: ML
authors.lastname: Fernandes
authors.forename: Kleber Costa de Castro
authors.initials: KC
authors.lastname: Pires