DOI: https://doi.org/10.14710/jai.v0i0.53139

Anesthesia Management in Blalock-Taussig Shunt Procedure

1Laboratory of Anesthesiology and Intensive Therapy, Faculty of Medicine, Mulawarman University/RSUD Abdoel Wahab Sjahranie, Samarinda, Indonesia

2Department of Anesthesiology and Post Operative Intensive Care Unit, Heart and Vascular Harapan Kita Hospital, Jakarta, Indonesia

Received: 19 Mar 2023; Revised: 1 Mar 2024; Accepted: 19 Feb 2024; Published: 31 Mar 2024.

Citation Format:
Cover Image
Abstract

Background: The systemic to pulmonary artery shunts are done as palliative procedures for complex cyanotic congenital heart diseases. Blalock-Taussig shunt (BT shunt) provide regulated blood flow to the lungs allowing growth of pulmonary arteries until the patient reaches proper age and body weight suitable for definitive corrective repair. BT shunts are first line management in patients with critical cyanotic conditions.

Case: A 12-month-old boy diagnosed with PA-VSD subaortic, L-R shunt PDA and critical PDA stenosis experienced a recurrent spell condition with the lowest oxygen saturation 40%, underwent urgent BT shunt surgery. Oxygen saturation increases to 80-85% after shunt procedure.

Discussion: Anesthesia management includes optimizing preoperative condition and patient hydration state, providing balance anesthesia during surgery, maintaining balance of pulmonary and systemic blood flow. High oxygen fraction can be given to maintain oxygen saturation before BT shunt anastomosis. Mechanical ventilation, heart rate with sinus rhythm, preload and contractility is maintained to obtain normal cardiac output. After BT shunt anastomosis, the oxygen fraction is reduced with a saturation target of 70–85%. Postoperative management includes anticoagulant administration and monitoring postoperative complications. The patient developed complications of increased pulmonary blood flow postoperatively and was admitted to the PICU for 3 days. The patient was discharged in good condition from ward on day 7.

Conclusion: Understanding the physiology of heart defects and perioperative management determine the success of BT shunt surgery, reducing patient morbidity and mortality. Optimizing intraoperative and postoperative oxygen delivery with oxygenation targets PaO2 40-45 mmHg and saturation 70-80% reflects the balance of pulmonary blood flow and systemic blood flow (Qp:Qs=0.7-1.5:1).

Note: This article has supplementary file(s).

Fulltext View|Download |  common.other
CTA
Subject
Type Other
  Download (685KB)    Indexing metadata
 common.other
Graphical Abstract
Subject
Type Other
  View (671KB)    Indexing metadata
Keywords: anesthesia management; blalock-taussig shunt; PA-VSD; perioperative management; pulmonary atresia

Article Metrics:

Article Info
Section: Case Reports
Language : EN
Recent articles
Postoperative Analgetic Profile in Pediatric Patients at Dr. Kariadi Hospital The Effects of Dexmedetomidine As an Adjuvant with Levobupivacaine To Epidural Analgesia on The Outcomes of Patients Undergoing Total Abdominal Hysterectomy Surgery Dexmedetomidine Effects on Surgical Stress Hormones Anesthesia in A Patient with Pulmonary Atresia with Intact Ventricular Septum (PA IVS) Underwent Bidirectional Cavo-Pulmonary Shunt (BCPS) Management of Patients Post Laminectomy Decompression Et Causa Spinal Cord Injury Cervical Vertebrae 1-7 with Hyperglikemia in Intensive Care Unit Ultrasound-Guided Supraorbital Nerve Block For Orbital Chronic Cancer Pain - A Case Report More recent articles
Most cited articles
Midazolam Intravena Dosis Rendah Tidak Mempengaruhi Nitric Oxide Intraperitoneal Mencit Balb/C Yang Terpapar Lipopolisakarida Patofisiologi Penyakit Jantung Koroner More cited articles
  1. Arrowsmith J, Roscoe A, Mackay J. Core Topics in Cardiac Anesthesia 3rd Ed. 2020. Cambridge: Cambridge University Press
  2. Kiran U, Aggarwal S, Choudhary A, Uma B, Kapoor PM. The Blalock and Taussig Shunt Revisited. Annals of Cardiac Anaesthesia. 2017; 20(3): 323-330
  3. Wasnick JD, Hillel Z, Kramer D, Littwin S, Nicoara A. Cardiac Anesthesia and Transesophageal Echocardiography. 2011. United States: McGraw Hill Company
  4. Ganigara M, Sagiv E, Buddhe S, Bhat A, Chikkabyrappa SM. Tetralogy of Fallot with Pulmonary Atresia: Anatomy, Physiology, Imaging and Perioperative Management. Seminars in Cardiothoracic and Vascular Anesthesia. 2020; 1–10
  5. Bentham JR, Zava NK, Harrison WJ, Shauq A, Kalantre A, Derrick G, et al. Duct Stenting Versus Modified Blalock-Taussig Shunt in Neonates with Duct-Dependent Pulmonary Blood Flow Associations With Clinical Outcomes in a Multicenter National Study. Circulation. 2018; 137: 581-588
  6. Nasr VG, Dinardo JA. The Pediatric Cardiac Anesthesia Handbook. 2017. Hoboken, NJ: John Wiley & Sons Ltd
  7. Gottschalk I, Strizek B, Jehle C, Stressig R, Herberg U, Breuer J, et al. Prenatal Diagnosis and Postnatal Outcome of Fetuses with Pulmonary Atresia and Ventricular Septal Defect. Ultraschall in Med. 2019
  8. Balaguru D, Dilawar M. Pulmonary Atresia with Ventricular Septal Defect: Systematic Review. Heart Views. 2007; 8(2):56-61
  9. Van de Woestijne P, Mokhles M, van Beynum I, de Jong, P Wilschut J, Bogers A. Staged correction of pulmonary atresia, ventricular septal defect, and collateral arteries. J Card Surg. 2022; 37: 960- 966
  10. Tchervenkov CI, Roy N. Congenital Heart Surgery Nomenclature and Database Project: Pulmonary Atresia-Ventricular Septal Defect. Ann Thorac Surg. 2000; 69: S97–105
  11. Hensley FA, Martin DE, Gravlee GP. A Practical Approach to Cardiac Anesthesia 5th Ed. 2013. Philadelphia: Lippincott Williams & Wilkins
  12. Holtby H. Anesthetic Considerations for Neonates Undergoing Modified Blalock-Taussig Shunt and Variations. Pediatric Anesthesia. 2014; 24: 114-119
  13. Zhou T, Wang Y, Liu J, Chen S, Zhou C, Dong N, et al. Pulmonary artery growth after Modified Blalock-Taussig shunt: A single centre experience. Asian Journal of Surgery. 2020; 43: 428-437
  14. Quinlan CA, Latham GJ, Joffe D, Ross FJ. Perioperative and Anesthetic Considerations in Tetralogy of Fallot with Pulmonary Atresia. Seminars in Cardiothoracic and Vascular Anesthesia. 2021; 25(3):218-228
  15. Junghare SW, Desurkar, V. Congenital heart diseases and anaesthesia. Indian Journal of Anaesthesia. 2017; 61(9): 744-752
  16. Andropoulos DB, Stayer S, Mossad EB, Miller-Hance WC. Anesthesia for Congenital Heart Disease 3rd Ed. 2015. New Jersey: John Wiley & Sons, Inc
  17. Sana MK, Ahmed Z. Pulmonary Atresia with Ventricular Septal Defect. National Library of Medicine. 2022. Bethesda: StatPearls Publishing LLC
  18. Davis PJ, Cladis FP, Motoyama EK. Smith's Anesthesia for Infants and Children 8th ed. 2011. United States: Mosby
  19. Loomba RS, Gray SB, Flores S. Hemodynamic effects of ketamine in children with congenital heart disease and/or pulmonary hypertension. Congenital Heart Disease. 2018;1–9
  20. Cote CJ, Lerman J, Anderson BJ, ed. A practice of anesthesia for infants and children 6th ed. 2019. Philadelphia: Elsevier
  21. Oofuvong M, Tanasansuttiporn J, Wasinwong W, Chittithavorn V, Duangpakdee P, Jarutach J, et al. Predictors of Death After Receiving a Modified Blalock-Taussig Shunt in Cyanotic Heart Children: A Competing Risk Analysis. PLoS ONE. 2021;16(1):1
  22. Dirks V, Prêtre R, Knirsch W, Buechelc ERV, Seifert B, Schweiger M, et al. Modified Blalock Taussig shunt: a not-so-simple palliative procedure. European Journal of Cardio-Thoracic Surgery. 2013; 44: 1096-1102
  23. Dutta P, Emani S, Ibla J, Emani S, Nathan M. Clinical implications of acute shunt thrombosis in paediatric patients with systemic-to-pulmonary shunt re-interventions. Cardiology in the Young. Cambridge University Press. 2022; pp1-7
  24. Vitanova K, Leopold C, von Ohain JP, Wolf C, Beran E, Lange R, et al. Reasons for Failure of Systemic-to-Pulmonary Artery Shunts in Neonates. Thorac Cardiovasc Surg. 2019; 67: 2–7
  25. Pota A, Bajpai P, Biyani G. Catheter-Directed Thrombolysis for Acute Blalock-Taussig Shunt Obstruction. Indian Journal of Clinical Cardiology. 2022; 3(2): 91-93

Last update:

No citation recorded.

Last update: 2024-04-30 01:50:33

No citation recorded.