Emergency deep hypothermic circulatory arrest in a 1 year old undergoing cardiac surgery in a Nigerian hospital - anaesthesia and critical care interventions

Abstract

Deep Hypothermic Circulatory Arrest (DHCA) is a technique used to obtain optimal operating conditions while providing cerebral protection. The case report presented a DHCA on an infant that was basically done as an emergency in an attempt to correct a previously unrecognized anomaly. We report a case of a 1 year old that had surgery for Ventricular Septal Defect (VSD) and Patent Ductus Arteriosus (PDA) ligation but following closure was noted to have no pulses on the lower limbs necessitating emergency reopening of the chest. Close Inspection revealed an Interrupted Aortic Arch with aberrant right subclavian artery and pre- surgery PDA supplying both upper and lower limb. DHCA was immediately commenced and the patient cooled to 16°C. The surgeon immediately set out to attach the subclavian artery to the ascending aorta and descending aorta. At the completion of the surgery, the patient was taken to Intensive Care Unit (ICU) for critical care support. She was subsequently discharged after spending a little more than a week in ICU. This procedure is rarely done as an emergency but was instituted in our case in effort to immediately achieve perfusion to the limbs. As the expertise to carry out the procedure is limited, it might be better to develop ways to efficiently ensure the skill set is continually updated.

Keywords

• deep hypothermic circulatory arrest
• cerebral perfusion
• interrupted aortic arch
• aberrant right subclavian artery
• ventricular septal defect
• patent ductus arteriosus