title: Cardiac Failure in a Trisomy 9 Patient Undergoing Anesthesia: A Case Report.
abstract: A 27-year-old female with Trisomy 9 mosaicism presented to Children's Hospital Colorado for outpatient dental surgery under general anesthesia. The patient's past medical history was also significant for premature birth, gastroesophageal reflux, scoliosis and kyphosis, obesity, and developmental delay. Per her mother's report, the patient had no cardiac issues. She had undergone multiple previous general anesthetics, some of which documented respiratory complications such as laryngospasm, bronchospasm, and possible aspiration. During this anesthetic, the patient became hypotensive on induction, with sluggish response to intravenous fluids, glycopyrrolate, and ephedrine. Her electrocardiogram demonstrated what appeared to be left bundle branch block at baseline, with possible ST segment changes after induction. Due to her abnormal reaction to the induction and subsequent treatment for hypotension, an echocardiogram was performed. The patient was found to have an ejection fraction of 25%-30%. The anesthetic was uneventful for the remainder of the procedure, and following recovery, the patient was admitted by the heart failure team for further care.
authors.affiliation: Department of Anesthesiology, Children's Hospital Colorado, Aurora, Colorado.
authors.forename: Cara J
authors.initials: CJ
authors.lastname: Riley
authors.affiliation: Department of Anesthesiology, Children's Hospital Colorado, Aurora, Colorado.
authors.forename: Timothy
authors.initials: T
authors.lastname: Moore
authors.affiliation: University of Colorado Medical School, Children's Hospital Colorado, Aurora, Colorado.
authors.forename: Lauren
authors.initials: L
authors.lastname: Eagelston
authors.affiliation: Department of Cardiology, Children's Hospital Colorado, Aurora, Colorado.
authors.forename: Dale
authors.initials: D
authors.lastname: Burkett
authors.affiliation: Department of Cardiology, Children's Hospital Colorado, Aurora, Colorado.
authors.forename: Scott
authors.initials: S
authors.lastname: Auerbach
authors.affiliation: Department of Anesthesiology, Children's Hospital Colorado, Aurora, Colorado.
authors.forename: Richard J
authors.initials: RJ
authors.lastname: Ing
mesh_terms: D000328:Adult; D000766:Anesthesia, Dental / Q000009:adverse effects*; D000768:Anesthesia, General / Q000009:adverse effects*; D002037:Bundle-Branch Block / Q000175:diagnosis / Q000209:etiology* / Q000503:physiopathology / Q000628:therapy; D002899:Chromosomes, Human, Pair 9 / Q000235:genetics; D017548:Echocardiography, Transesophageal; D004562:Electrocardiography; D005260:Female; D006333:Heart Failure / Q000175:diagnosis / Q000209:etiology* / Q000503:physiopathology / Q000628:therapy; D006801:Humans; D009030:Mosaicism; D013318:Stroke Volume; D014081:Tooth Extraction; D014314:Trisomy / Q000235:genetics*; D024182:Uniparental Disomy / Q000235:genetics*
keywords: Cardiac failure; Cardiomyopathy; General anesthesia; Trisomy 9 mosaic