Total anomalous pulmonary venous connection (TAPVC) was once a common congenital heart disease associated with high morbidity and mortality rates in infancy. However, currently, the prognosis for surgical treatment is better, with an early mortality rate of 2%–15% and a 10-year survival rate of approximately 90%. We report the general anesthetic management of a pediatric patient with developmental delay and pulmonary arterial hypertension after surgery for TAPVC.
A 7-year-old boy (weight, 18 kg ; height, 111 cm) was diagnosed with TAPVC at 14 days of age owing to hypoxemia and underwent radical TAPVC surgery at 16 days of age. Postoperatively, he developed pulmonary arterial hypertension and cerebellar infarction, and continued to receive treatment, thereafter. Long-term warfarin was administered for cerebral infarction, and as his progress was good, we decided to discontinue this medication. At that time, we planned to perform dental treatment under general anesthesia.
Considering the patient’s respiratory reserve and degree of mental developmental delay, slow anesthetic induction was performed without the use of sedatives. We also prepared circulatory agents to address perioperative hypotension and nitric oxide inhalational therapy in the case of increased pulmonary vascular resistance.
When anesthetizing a child after radical surgery for TAPVC, anesthesiologists should determine the appropriate time for surgery after assessing the postoperative risks and the patient’s preoperative general condition. Additionally, anesthesiologists should consider the induction method in light of the child’s level of mental development and circulatory changes, and prepare adequately for emergency situations.
View full abstract