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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.

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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).

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Keywords: anesthesia management; blalock-taussig shunt; PA-VSD; perioperative management; pulmonary atresia

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