Differential cyanosis and undiagnosed eisenmenger′s syndrome: The importance of pulse oximetry

Abstract

Eisenmenger's physiology has significant anesthetic implications. The symptamology, in the early course of disease can be subtle at times and missed on regular PAC. Pulse oximetry, in our patient detected differential saturations. The possibility of underlying congenital cardiac illness was assumed, rescheduling of case was debated and finally the abnormal cardiac lesions were identified in ECHO in immediate postoperative period.

Echocardiographic changes in the progress of reverse shunt and improvement to left‐to‐right shunt after medical treatment in dogs with bidirectional patent ductus arteriosus or ventricular septal defect: A report of two cases

“…Due to the location of the duct, deoxygenated blood enters the aorta distal to the left subclavian artery, and brachiocephalic circulation remains normal (Sharma et al, 2014).…”

“…In particular, in patients with PDA with pulmonary hypertension, the term ‘differential cyanosis’ is used, which refers to cyanosis of the lower extremities, but with normal upper extremities. Due to the location of the duct, deoxygenated blood enters the aorta distal to the left subclavian artery, and brachiocephalic circulation remains normal (Sharma et al., 2014 ).…”

Navigating Neonatal Cardiovascular Emergencies: A Comprehensive Narrative Review on Assessment and Intervention Strategies

“…Differential cyanosis is characterized by the manifestation of cyanosis in both lower extremities, while the right arm or both arms remain pink. 11,12 The explanation to this phenomenon is that in patients with pulmonary arterial hypertension and patent ductus arteriosus (PDA), the deoxygenated blood in the pulmonary artery enters the PDA and travels to the aorta and from thereon to the lower half of the body. The color of the left arm depends on where the PDA enters the aorta: if below the left subclavian artery, then the left arm is pink, as it receives blood from the left ventricle, same as the right arm.…”

“…Differential cyanosis also appears in persistent pulmonary hypertension of the newborn associated with critical aortic stenosis or coarctation, interrupted or hypoplastic aortic arch. 11,12 Reverse differential cyanosis is encountered in newborns with transposition of the great arteries associated with high pulmonary vascular resistance, coarctation of the aorta, or interrupted aortic arch. In both cases, the descending aorta receives blood from the pulmonary circulation via a patent PDA, therefore the legs are pink and the arms are cyanotic.…”

Anesthetic management of an adult patient with uncorrected ventricular septal defect posted for open cholecystectomy

“…[3] The cyanotic CHD present early in childhood, but acyanotic CHD may be relatively asymptomatic till later in life, because of balance between the systemic and pulmonary circulations. [4] Ventricular septal defect (VSD), one of the commonest acyanotic heart diseases, can occur as an isolated defect or as a component of a combination of anomalies. Usually, isolated small-or moderate-sized defects are initially detected in adulthood and can present with significant perioperative morbidity and mortality, if not evaluated carefully and managed meticulously.…”