We report a successful surgical management of a case presented with a combination of aortopulmonary window (APW) with large ventricular septal defect (VSD) amounting to a single ventricle, with a view to highlight technical considerations during staged single-ventricle palliation.
Muscular VSDs can be mapped through en face reconstruction and closed using intraoperative customized double-patch device technique in a variety of situations with satisfactory immediate and short-term results.
In adult population after bicuspid aortic valve, atrial septal defect (ASD) is the most common congenital acyanotic heart disease, with high prevalence in females. Large ASD with pulmonary hypertension (PAH) posted for non-cardiac surgery poses a challenge to anaesthesiologists because intraoperative hypercarbia, hypoxemia, and hyperthermia can result in increased pulmonary vascular resistance (PVR), which can result in shunt reversal, congestive heart failure, and fatal arrhythmias. We report successful anaesthetic management of 48yrs female case of recurrent astrocytoma posted for craniotomy. Patient was having large ostium secundum ASD (35 mm in diameter), with severe PAH having PASP 75mmhg by TR jet, with dilated RA/RV, moderate TR and LVEF 55% under GA, with titrated induction, avoiding rise in PVR and maintaining systemic vascular resistance (SVR) with vasopressors intraoperatively to avoid shunt reversal.:To concludepatients with severe PHT due to large ASD, require meticulous intraoperative management to prevent any rise in PAH, and maintenance of systemic vascular resistance with optimal oxygen delivery and excellent postoperative analgesia for excellent outcome.
Pulmonary endarterectomy (PEA) is a potentially curative procedure for chronic thromboembolic pulmonary hypertension. A 34-year Indian male presented with supra-systemic pulmonary pressure was taken for PEA after achievable optimization. A successful PEA was performed with the help of total cardiac arrest. Patient developed reperfusion pulmonary edema post operatively, which was managed medically. The problems encountered by anesthesiologists in this case were preoperative pulmonary hypertension with chronic hypoxia and postoperative management of reperfusion pulmonary edema.
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