Pulmonary Hypertension and Major Surgery (original) (raw)
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Annals of Cardiac Anaesthesia, 2016
Fontan's circulation is a unique challenge for the anesthesiologist. Venous pressure is the only source of blood flow for the pulmonary circulation. Patients with such circulation are extremely sensitive to progression of cyanosis (decreased pulmonary blood flow) or circulatory failure. Any major venous compression can compromise the pulmonary blood flow worsening cyanosis; simultaneously, an increased afterload can precipitate circulatory failure. We present a rare patient of surgically corrected Ivemark syndrome with Fontan's physiology with dextrocardia who developed a large uterine fibroid compressing inferior vena cava (IVC). As a result of compression, not only the pulmonary circulation was compromised but she also developed stasis-induced venous thrombosis in the lower limbs that lead to pulmonary embolism (PE) (increased afterload). In addition to oral anticoagulation an IVC filter was inserted to prevent ongoing recurrent PE. Further, to prevent both circulatory compromise and deep venous thrombosis an urgent myomectomy/ hysterectomy was planned. In the present case, we discuss the issues involved in the anesthetic management of such patients and highlight the lacunae in the present guidelines for managing perioperative anticoagulation these situations.
Anaesthesia for caesarean section in the presence of severe primary pulmonary hypertension
British Journal of Anaesthesia, 1998
Introduction: Pulmonary hypertension is a rare condition and in combination with pregnancy, it can result in high maternal mortality. Mitral stenosis is one of the complicated cardiac diseases that may occur during pregnancy. In this report, we describe our management of such a case, which was even more difficult in combination with pulmonary hypertension, mitral stenosis, and aortic and tricuspid valve insufficiency requiring emergency caesarean section under general anaesthesia. Case presentation: A 29-year-old primiparae was presented to the anaesthetic department for an urgent caesarean section with a diagnosis of severe pulmonary hypertension in combination with mitral stenosis. The patient was hospitalized prepartum and received oxygen therapy and anticoagulation with heparin. The patient was monitored during labour and delivery with oximetry and arterial and central venous pressure line. Pulmonary arterial lines were not used due to an increased risk and questionable usefulness. Echocardiography revealed a systolic pulmonary arterial pressure of 75 mmHg, and mitral stenosis, aortic and tricuspid valve insufficiency. We decided to proceed under general anaesthesia. Anaesthesia was induced with etomidate, and succinylcholine. Dopamine and nitroglycerin infusion was preoperatively started and infusion was also preoperatively continued. Hemodynamic parameters were stable during delivery. Neonatal weight and apgar score were satisfactory. After the delivery of a healthy baby, oxytocin was administered. Surgery was completed uneventfully. During the postoperative period, the patient received furosemide and morphine. As the arterial blood gas analyses were stable and the chestray was normal, the patient was extubated postoperatively in the second hour in ICU. Conclusion: Patients with significant multivalvular heart disease require careful preoperative, multidisciplinary assessment and anesthetic planning before delivery in order to optimize cardiac function during the peripartum period and make informed decisions regarding the mode of delivery and anaesthetic technique.
Journal of Anesthesia & Critical Care: Open Access, 2015
Atrial septal defect (ASD) is a common cardiac anomaly that may be first encountered in the adults and occurs more frequently in females. ASD accounts for 10% of congenital cardiac defects in adults. A 50 year old female patient posted for Total Abdominal Hysterectomy was diagnosed to have ostium secundum large ASD with mild tricuspid regurgitation with moderate pulmonary hypertension and mild essential hypertension. We report the successful management of the case using combined general anaesthesia with Bilateral Transversus Abdominis plane (TAP) block for postoperative analgesia. During the general anesthesia for the procedure our objectives were to avoid hypotension, hypoxemia, hypercarbia, hypothermia, reversal of shunt and fluid overload and postoperative analgesia by TAP block, The patient had an eventful perioperative course and discharged from the hospital on the 5 th-postoperative day in good physical condition.
Postoperative pulmonary complications after gynecologic surgery
International Journal of Gynecology & Obstetrics, 2006
Objective: Investigate the frequency of, and risks for postoperative pulmonary complications after surgery for non-malignant gynecologic disorders. Method: A retrospective component included medical record data for one year. A prospective component enrolled 300 patients consecutively who were scheduled for gynecologic surgeries. Result: Postoperative pulmonary complications occurred in 1.22% of 328 open abdominal procedures in the retrospective study, and 2.16% of 232 in the prospective study. Pooling the data yielded a frequency estimate of 1.61%. Mean hospital length of stay (pooled data) increased 1.75 days in those with postoperative pulmonary complications. Smoking was the only significant risk factor (relative risk = 3.9 using pooled data). Conclusion: Postoperative pulmonary complications after surgery for non-malignant gynecologic disorders are infrequent but increase hospital length of stay. Smokers are at increased risk.
Chronic thromboembolic pulmonary hypertension in young woman with history of caesarian section
Medical Journal of Indonesia, 2015
Hipertensi pulmonal tromboemboli kronik merupakan salah satu subgrup dari hipertensi pulmonal. Penyakit ini merupakan kondisi medis yang sangat serius dan seringkali tidak terdiagnosis. Hipertensi pulmonal tromboemboli kronik umumnya tidak terdiagnosis karena gejala yang tidak spesifik dan kurangnya alat diagnostik. Tujuan presentasi ini adalah untuk menjelaskan mengenai etiologi, faktor resiko, diagnosis dan manajemen hipertensi pulmonal tromboemboli kronik. Wanita berusia 36 tahun datang dengan keluhan utama mudah lelah dan sesak bila beraktifitas sejak dua tahun yang lalu. Gejala ini timbul sekitar tiga bulan setelah melahirkan dengan seksio caesaria atas indikasi preeklampsi. Anamnesa lebih lanjut, pemeriksaan fisik, EKG dan ekokardiografi sangat mendukung ke arah diagnosis hipertensi pulmonal. Dari pemeriksaan sonografi vaskuler femoral tidak didapatkan adanya trombosis vena dalam (DVT). Scan perfusi paru menunjukkan bahwa pasien ini mengalami hipertensi pulmonal tromboemboli kronik. CT pulmonary angiography (CTPA) tidak mendapatkan adanya trombus sehingga pasien ini tidak layak dioperasi endarterektomi pulmonal. Pasien ini kemudian diterapi dengan vasodilator pulmonal, ACE inhibitor, diuretik dan mendapat antikoagulan oral untuk seumur hidup.
The Internet Journal of Anesthesiology, 2008
Eisenmengers Syndrome consists of pulmonary hypertension and a right-to-left or bidirectional shunt with peripheral cyanosis. The shunt may be atrial, ventricular, or aortopulmonary. It is commonly found with left to right shunt reversal during end stages of PDA, VSD, and ASD. The presence of Eisenmengers syndrome places the pregnant patient at a high risk for maternal and neonatal mortality. The associated high pulmonary artery pressure with fixed vascular resistance are not reversed surgically. The prognosis of the same being dependent on the pulmonary hypertension. We discuss a case management of a primigravida with PDA and Eisenmengerisation in 28 weeks of gestation presenting with breathlessness.
Thoracic aorta aneurysm successfully operated on during pregnancy
W pracy przedstawiono przypadek 26-letniej pacjentki będącej w II trymestrze ciąży, u której rozpoznano bardzo dużego, bezobjawowego tętniaka prawdziwego aorty wstępującej. W wywiadzie -przebyta operacja koarktacji aorty w 15. roku życia i rozpoznana dwupłatkowa zastawka aortalna. Pacjentkę zoperowano w 22. tygodniu ciąży, wszczepiając prostą protezę nadwieńcowo. Operację przeprowadzono w krążeniu pozaustrojowym z pozostawieniem dobrze funkcjonującej zastawki aortalnej. Nie stwierdzono komplikacji w okresie pooperacyjnym. W 38. tygodniu ciąży pacjentka urodziła zdrowe dziecko z 10 punktami w skali Apgar. U pacjentki zaplanowano zabieg wszczepienia stengraftów do aorty zstępującej, ponieważ badanie tomograficzne klatki piersiowej wykonane kilka miesięcy po porodzie potwierdziło obecność dużego tętniaka poniżej odejścia lewej tętnicy podobojczykowej. Słowa kluczowe: tętniak aorty, ciąża, operacja kardiochirurgiczna.