Abstract
We report a case of a 15-year-old girl who underwent the left lower lobectomy for a complex type of pulmonary arteriovenous fistula, which caused a huge right-to-left shunt in the pulmonary circulation. During the operation with one-lung ventilation anesthesia, the right heart failure in company with severe hypoxemia or malignant ventricular arrhythmias, might be induced as the result of the sudden reduction of shunt flow. Furthermore, possible pulmonary edema due to ischemic reperfusion-like injury might be possible to develop by fluid overload, after the normal pulmonary perfusion restarted. FloTrac/Vigilleo SystemTM can provide useful hemodynamic parameters such as arterial pressure-based cardiac output and stroke volume variation based on the concept of fluid responsiveness. In our case, this system was successfully applied to achieve optimal cardiac preload for organ perfusion without transfusion and to prevent the right heart failure and pulmonary edema.
