Journal of Pain Research (Jul 2019)
Anesthetic management in untreated Bland-White-Garland syndrome: a case report and literature review
Abstract
Qiao Guo, Yuan-Jing Chen, He HuangDepartment of Anesthesiology, The Second Affiliated Hospital of Chongqing Medical University, Chongqing 400010, People’s Republic of ChinaAbstract: Bland-White-Garland syndrome (BWGS) is a rare congenital coronary artery malformation. In adult patients with BWGS, left coronary artery is supplied by collateral vessels from dilated right coronary artery. When high-pressure coronary flow drains into the low-pressure pulmonary artery with little ventricle perfusion, it causes a “coronary steal”. In this study, a 53-year-old man with untreated BWGS receiving choledochotomy under general anesthesia was presented. The patient suffered from chronic biliary calculi, atrial fibrillation, complete left bundle branch block, and chronic heart failure. The anesthetic management for choledochotomy in this patient presented a special challenge. Moreover, relevant literature search was performed for all the case reports of BWGS published in PubMed and MEDLINE from 1990 to 2018. In addition, a summary of underlying pathophysiology and anesthetic implications of patients with BWGS was provided.Keywords: anesthesia, Bland-White-Garland syndrome, left main coronary artery, right coronary artery, pulmonary artery, coronary steal
