Anesthesia for Right‐Sided Obstructive Lesions

Schmitz, Michael L.; Ullah, Sana

doi:10.1002/9781444314328.ch22

Cited by 4 publications

(12 citation statements)

References 60 publications

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“…RVOTO at an earlier developmental stage results in more severe degrees of RV hypoplasia, TV hypoplasia, and RV-coronary fistulas. 3,4 Because the ductus arteriosus supplies adequate pulmonary blood flow (PBF) in utero, the main pulmonary artery and branch pulmonary arteries are normal in caliber. 8…”

Section: Embryology Anatomy and Classificationmentioning

confidence: 99%

“…At a critical point, sufficient myocardium is at risk of developing severe ischemia if RV hypertension is relieved by surgical RV decompression. 1,3,4,11 Stenoses or occlusions of both the right and left coronary systems as well as coronary isolation of a significant portion of myocardium are independent risk factors for death if RV decompression is performed. 11 In complete RVDCC with absent aortocoronary connections, there is no possibility of collateral antegrade perfusion from other coronary arteries.…”

Section: Rv-coronary Fistulas and Rv-dependent Coronary Circulationmentioning

confidence: 99%

“…RV and coronary angiography are used to confirm the presence and extent of LV myocardial dependence on the coronary flow from the RV. 4,5,8,20,21 Noninvasive imaging, such as chest computed tomography (CT) may be an alternative to cardiac catheterization in diagnosing coronary artery abnormalities; however, cardiac catheterization remains the preferred diagnostic tool due to the ability to simultaneously preform therapeutic interventions. 3,8,22…”

Section: Evaluation and Preoperative Managementmentioning

confidence: 99%

“…These include the appropriate stratification of patients to single-ventricle or biventricular treatment pathways, separation of systemic and pulmonary circulations to eliminate cyanosis, opportunity for RV growth, and avoiding systemic venous hypertension. 4,5,24…”

Section: Interventional and Surgical Managementmentioning

confidence: 99%

“…Based on the degree of disease, surgical approaches generally involve single, 1.5, or biventricular palliation/repair. 3-6 Consequently, appropriate perioperative and anesthetic management requires a thorough understanding of the specific anatomy and physiology on a case-by-case basis. Special perioperative considerations are required in the presence of RV-dependent coronary circulation (RVDCC), as those patients are at particularly high risk of cardiovascular collapse related to ischemia.…”

Section: Introductionmentioning

confidence: 99%

See 4 more Smart Citations

Perioperative and Anesthetic Considerations in Pulmonary Atresia With Intact Ventricular Septum

Gleich

Latham

Joffe

et al. 2017

Semin Cardiothorac Vasc Anesth

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Pulmonary atresia with intact ventricular septum (PA/IVS) is a rare right-heart obstructive lesion with a wide anatomic and physiologic spectrum of disease, ranging from simple membranous pulmonary valve atresia with a fully developed right ventricle (RV) to a severely hypoplastic RV and ventriculocoronary (RV-coronary) fistulas. Affected neonates are dependent on prostaglandin for adequate pulmonary blood flow. Depending on the severity of disease, treatment options range from transcatheter pulmonary valve perforation and ultimate biventricular repair to staged single-ventricle palliation. Cardiac transplantation is recommended in the most severe cases. This review will discuss the perioperative and anesthetic management of patients with PA/IVS and highlight the challenges in management.

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Section: Embryology Anatomy and Classificationmentioning

confidence: 99%