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Anaesthetic management of a case of large ASD with severe pulmonary hypertension—case presentation
Author(s) -
Vikram Madaan,
Rekha Gupta
Publication year - 2022
Publication title -
ain shams journal of anesthesiology
Language(s) - English
Resource type - Journals
eISSN - 2090-925X
pISSN - 1687-7934
DOI - 10.1186/s42077-022-00232-3
Subject(s) - medicine , pulmonary hypertension , cardiology , palpitations , bicuspid aortic valve , heart failure , eisenmenger syndrome , anesthesia , surgery , aortic valve
Background Atrial septal defect is the most common acyanotic congenital cardiac anomaly in the adults after bicuspid aortic valve with high prevalence in females. Major challenges in the management of large ASD with severe pulmonary hypertension includes hypoxemia, hypercarbia, hypothermia leading to reversal of shunt (Eisenmenger syndrome), fatal arrhythmias and congestive heart failure. Case presentation We report the successful management of the case of 44-year-old female patient with large ASD and severe pulmonary arterial hypertension posted for total abdominal hysterectomy with salpingectomy. She had history of palpitations with exertional dyspnoea and history of abnormal uterine bleeding with failed medical treatment. Echocardiography showed large OS-ASD (24 mm) with left to right shunt, moderate TR, severe PAH with estimated RVSP 60 mmHg, LVEF 50% and grossly dilated RA/RV. She underwent total abdominal hysterectomy with salpingectomy under regional anaesthesia with prophylactic use of adrenaline infusion. Conclusions Cardiac patients for non-cardiac surgery can be managed under regional anaesthesia.

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