Laparoscopic colectomy in an adult with single ventricle physiology: Anesthetic implications and management

Abstract

Increasing numbers of adult patients with complex congenital heart conditions are presenting for noncardiac surgery later in life. These disorders can present challenges for surgical and anesthesia providers. Specifically, single ventricle lesions offer anatomic and physiologic concerns during the perioperative period. Single ventricle physiology represents a delicate balance between systemic and pulmonary blood flow. Any alterations in blood flow through these systems can produce undesirable hemodynamic changes, especially during the perioperative period. We present a case of an adult patient with a single left ventricle who presented for laparoscopic total colectomy due to inflammatory bowel disease. His abnormal anatomy coupled with the hemodynamic disruptions caused by laparoscopy presented significant anesthetic challenges. We highlight the anesthetic concerns of single ventricle physiology, specifically pertaining to laparoscopic surgery. We provide recommendations for safely managing these patients perioperatively. With detailed preoperative evaluation and close hemodynamic monitoring during the perioperative period, these patients can experience successful surgical and anesthetic outcomes.

Keywords

• Cardiac surgery; Coronary artery bypass grafting; European system for cardiac operative risk evaluation; Risk factor
• After drop; Extravascular lung water; Fluid balance
• Anesthesia; pregnancy; pulmonary hypertension
• Cardiac surgery; heart disease; mortality; postoperative complications; risk stratification in cardiac surgery
• Cardiac anesthesia; Etomidate; Propofol
• CPB
• Cardiac computerized tomographic angiography; Congenital heart disease; General anesthesia
• Image quality; Induced apnea
• Extracorporeal membrane oxygenation; simulation; training
• Mitral valve prolapse; NeoChord delivery system; three-dimensional transesophageal echocardiography
• Congenital heart defect; Transesophageal echocardiogram; Tei index
• Cardiac surgery; dissociative anesthesia; intensive care; ketamine
• Cardiac surgery; hospital-acquired infection; infection; procalcitonin; sepsis
• Aortic dissection; ascending; intimo-intimal intussusception; Stanford type A
• Anesthesia induction; impaled knife in the back; airway management
• Pulmonary vascular resistance; Transesophageal echocardiography; Truncus arteriosus
• On table extubation; Safety; Tetralogy of Fallot; Total correction
• High-risk abdominal surgery; Myocardium at risk; Perioperative use of intra-aortic balloon pump; Subclavian artery stenosis
• Prosthetic valve aortic stenosis; prosthetic valve mitral stenosis; transcatheter aortic valve replacement; transcatheter
• Anesthesia; Blalock-Taussig shunt; Congenital heart disease; Laparoscopic surgery; Single ventricle physiology