Open AccessAnesthetic management of a case of Gilbert's syndrome for mitral and aortic valve replacement: Role of transesophageal echocardiography
Author(s) -
P S Nagaraja,
Naveen G Singh,
S Subash,
N Manjunatha,
C G Prabhushankar,
Narayanan Sathish
Publication year - 2017
Publication title -
saudi journal of anaesthesia
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.416
H-Index - 24
eISSN - 1658-354X
pISSN - 0975-3125
DOI - 10.4103/1658-354x.197335
Subject(s) - medicine , cardiopulmonary bypass , cardiology , perfusion , tricuspid valve , anesthetic , mitral valve replacement , mitral valve , cardiac surgery , aortic valve replacement , anesthesia , stenosis
Gilbert's syndrome (GS) is an autosomal inherited disorder characterized by relative deficiency of glucuronyl transferase and poor uptake of unconjugated bilirubin by hepatocytes. Cardiac surgery on cardiopulmonary bypass (CPB) in these patients triggers further hepatic dysfunction. Transesophageal echocardiography (TEE) and Doppler assessment of hepatic vein help in assessing hepatic blood flow (HBF) during cardiac surgery. Here, we discuss anesthetic management and role of TEE in maintaining HBF perioperatively in a 25-year-old male patient with GS undergoing double valve replacement with tricuspid valve plasty. TEE-guided HBF monitoring and management of hepatic perfusion by modifying anesthetic and CPB protocol resulted in the favorable outcome.