title: A case of anastomosis malposition of the Blalock-Taussig shunt diagnosed using perioperative transesophageal echocardiography monitoring.
abstract: The perioperative transesophageal echocardiography (TEE) is a very useful and minimal invasive monitoring not only for the cardiac anesthesia management, but also for the anesthesia management of the non-cardiac operations of the heart high risk patients. In this case report, we report a case of the urgent Blalock-Taussig shunt (BT shunt) operation for a small patient of Fallot's tetralogy with anoxic spell, which showed an atypical change of hemodynamics and SpO2 with the shunt opening. After the BT shunt anastomosis, the diastolic blood pressure decreased with the shunt opening, however, the expected rise of SpO2 was not provided. By the perioperative TEE monitoring with the single plane TEE transducer for neonate; UST-52110S (Hitachi Aloka Medical, Tokyo, Japan) with 4.5 mm in diameter, the cause of this atypical change of hemodynamics and SpO2 was diagnosed to be an accidental anastomosis malposition of the BT shunt to the right pulmonary vein and reported to the operator during the operation, and the operation was performed correctly.
authors.affiliation: Department of Pediatric Anesthesiology and Critical Care Medicine, Children's Hospital Asklepios Klinik Sankt Augustin, Arnold-Janssen-Str. 29, 53757, Sankt Augustin, Germany, t.yamamoto@asklepios.com.
authors.forename: Tomohiro
authors.initials: T
authors.lastname: Yamamoto
authors.forename: Ehrenfried
authors.initials: E
authors.lastname: Schindler
mesh_terms: D058366:Blalock-Taussig Procedure / Q000295:instrumentation / Q000379:methods*; D017548:Echocardiography, Transesophageal / Q000379:methods*; D006801:Humans; D000860:Hypoxia / Q000175:diagnosis / Q000209:etiology / Q000517:prevention & control*; D007231:Infant, Newborn; D016343:Monitoring, Intraoperative / Q000379:methods; D019919:Prosthesis Implantation / Q000379:methods*; D012086:Reoperation; D025321:Surgery, Computer-Assisted / Q000379:methods*; D013771:Tetralogy of Fallot / Q000150:complications / Q000175:diagnosis* / Q000601:surgery*; D016896:Treatment Outcome
references.citation: Circulation. 1991 Mar;83(3):817-21
references.pmid: 1999032
references.citation: Anaesth Intensive Care. 1998 Jun;26(3):287-93
references.pmid: 9619224
references.citation: J Cardiothorac Vasc Anesth. 1998 Dec;12(6):625-32
references.pmid: 9854658
references.citation: Anesth Analg. 1996 Jun;82(6):1139-45
references.pmid: 8638781
references.citation: Anesth Analg. 2001 May;92(5):1126-30
references.pmid: 11323333
references.citation: Can J Anaesth. 2000 Jan;47(1):20-6
references.pmid: 10626713