Anestesia para correção de tetralogia de Fallot em paciente adulto: relato de caso

Michelle Nacur Lorentz; Bayard Gontijo Filho

doi:10.1590/S0034-70942007000500007

Scientific Article

Anestesia para correção de tetralogia de Fallot em paciente adulto: relato de caso

Anesthesia for repair of tetralogy of Fallot in an adult patient: case report

Michelle Nacur Lorentz; Bayard Gontijo Filho

http://dx.doi.org/10.1590/S0034-70942007000500007 Braz J Anesthesiol, vol.57, n5, p.525-532, 2007

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Resumo

JUSTIFICATIVA E OBJETIVOS: A cardiopatia congênita é um dos problemas mais comuns ao nascimento acometendo 1 a 1,5 em cada 10.000 nascidos vivos. Atualmente mais de 85% das crianças com cardiopatias congênitas chegam à idade adulta em parte devido aos novos tratamentos, mas sobretudo em virtude da tendência de se realizarem correções cirúrgicas mais precoces. Por outro lado, é raro encontrar um adulto com tetralogia de Fallot (T4F) não-corrigida. O objetivo do presente relato foi descrever um caso de T4F submetido à correção cirúrgica na idade adulta. RELATO DO CASO: Paciente de 45 anos, sexo feminino, portadora de T4F internada para realização de correção cirúrgica. Ao exame físico apresentava-se cianótica nas extremidades e com saturação de oxigênio (SpO2) de 73%. Foi realizada anestesia geral balanceada com etomidato, fentanil, pancurônio e sevoflurano. A correção cirúrgica realizada foi o fechamento da comunicação ventricular e interposição de conduto valvado pulmonar n° 24, posteriormente foi fenestrado o septo ventricular. À saída de circulação extracorpórea (CEC) foram administradas milrinona e dopamina. A SpO2 ao fim da operação era 97%. Após o procedimento cirúrgico a paciente foi encaminhada ao CTI, onde permaneceu por 72 horas e teve alta hospitalar no oitavo dia pós-operatório em boas condições. CONCLUSÕES: O caso ilustrou sucesso de intervenção cirúrgica em paciente de alto risco com grande interação entre cirurgião, anestesista e terapia intensiva.

Palavras-chave

ANESTESIA, Cardíaca, DOENÇAS, Cardíaca

Abstract

BACKGROUND AND OBJECTIVES: Congenital cardiopathy is one of the most common problems at birth, with an incidence of 1 to 1.5 in 10,000 live births. Currently, more than 85% of children with congenital cardiopathy survive to adulthood, partly due to the development of new therapies, but especially because of the tendency for earlier surgical corrections. On the other hand, adult patients with non-corrected tetralogy of Fallot (TOF) are hard to find. The objective of the present report was to describe a case of repair of TOF in an adult patient. CASE REPORT: A female patient, 45 years old, with TOF, was admitted for surgical repair of her condition. Physical exam revealed extremities with cyanosis and oxygen saturation (SpO2) of 73%. General balanced anesthesia consisted of ethomidate, fentanyl, pancuronium and sevoflurane. During the surgery, the ventricular communication was closed, placement of a 24 French prosthetic conduit with valve and, posteriorly, the ventricular septum was fenestrated. Milrinone and dopamine were administrated when extracorporeal circulation (ECC) was removed. At the end of the surgery SpO2 was 97%. After the procedure the patient was admitted to the ICU where she remained for 72 hours, being discharged from the hospital on the eighth postoperative day in good condition. CONCLUSIONS: This case illustrated the successful surgical repair in a high-risk patient, with a very good interaction among the surgeon, anesthetist, and intensive care.

Keywords

ANESTHESIA, Cardiac, DISEASES, Cardiac

Referências

Deanfield J, Thaulow E, Warnes C. Management of grown up congenital heart disease. Eur Heart J. 2003;24:1035-1084.

Lovell AT. Anaesthetic implications of grow-up congenital heart disease. Br J Anaesth. 2004;93:129-139.

Warner MA, Lunn RJ, O'Leary PW. Outcomes of noncardiac surgical procedures in children and adults with congenital heart disease. Mayo Clin Proc. 1998;73:728-734.

Betranou EG, Blackstone EH, Hazelrig JB. Life expectancy without surgery in tetralogy of Fallot. Am J Cardiol. 1978;42:458-466.

Makaryus AN, Aronov I, Diamond J. Survival to the age of 52 years in a man with unrepaired tetralogy of Fallot. Echocardiography. 2004;21:631-637.

Flanagan MF, Hourihan M, Keane JF. Incidence of renal dysfunction in adults with cianotic congenital heart disease. Am J Cardiol. 1991;68:403-406.

Gatzoulis MA, Balaji S, Webber AS. Risk factors for arrhythmia and sudden cardiac death late after repair of tetralogy of Fallot: a multicentre study. Lancet. 2000;356:975-981.

Nollert G, Fischlein T, Bouterwek S. Long-term survival in patients with repair of tetralogy of Fallot: 36 year follow-up of 490 survivors of the first year after surgical repair. J Am Coll Cardiol. 1997;30:1374-1383.

Niezen RA, Helbing WA, van Der Wall EE. Left ventricular function in adults with mild pulmonary insufficiency late after Fallot repair. Heart. 1999;82:697-703.

Dimopoulos K, Okonko DO, Diller GP. Abnormal ventilatory response to exercise in adults with congenital heart disease relates to cyanosis and predicts survival.. Circulation. 2006;113:2796-2802.

Chowdlhury UK, Sathia S, Ray R. Histopathology of the right ventricular outflow tract and its relationship to clinical outcomes and arrhythmias in patients with tetralogy of Fallot. J Thorac Cardiovasc Surg. 2006;132:270-277.

Heggie J, Poirer N, Williams WG. Anesthetic considerations for adult cardiac surgery patients with congenital heart disease. Semin Cardiothorac Vasc Anesth. 2003;7:141-152.

DeFillipis AP, Law K, Curtin S. Blood is thicker than water: the management of hyperviscosity in adults with cyanotic heart disease. Cardiol Rev. 2007;15:31-34.

Erdoan HB, Bozbua N, Kayalar N. Long-term outcome after total correction of tetralogy of Fallot in adolescent and adult age. J Card Surg. 2005;20:119-123.

Lu X, Wu X, Gu X. Long-term results of survival treatment of tetralogy of Fallot in adults. Thorac Cardiovasc Surg. 2006;54:295-299.

Huntington JH, Malviya S, Voepel-Lewis T. The effect of a right-to-left intracardiac shunt on the rate of rise of arterial and end-tidial halothane in children. Anesth Analg. 1999;88:759-762.

Laird TH, Stayer AS, Rivenes SM. Pulmonary-to-systemic blood flow ratio effects of sevoflurane, isoflurane, halothane, and fentanyl/midazolan with 100% oxygen in children with congenital heart disease. Anesth Analg. 2002;95:1200-1206.

Checchia PA, Backer CL, Bronicki RA. Dexamethasone reduces postoperative troponin levels in children undergoing cardiopulmonar bypass. Crit Care Med. 2003;31:1742-1745.

Prasongsukarn K, Abel JG, Jamieson WR. The effects of steroids on the ocorrence of postoperative atrial fibrillation after coronary artery bypass grafting: a prospective randomizes trial. J Thorac Cardiovasc Surg. 2005;130:93-98.

Sodha NR, Boodhwani M, Bianchi C. Aprotinin in cardiac surgery. Expert Rev Cardiovasc Ther. 2006;4:151-160.

Chong AJ, Hamton CR, Shimamoto A. Microvascular inflamatory responses in cardiac surgery. Semin Cardiothorac Vasc Anesth. 2003;7:333-354.

Yavuz S, Ayabakan N, Dilek K. Renal dose dopamine in open heart surgery: Does it protect renal tubular function?. J Cardiovasc Surg. 2002;43:25-30.

Tang AT, El-Gamel A, Keevil B. The effect of "renal dose" dopamine on renal tubular function following cardiac surgery: assessed by measuring retinol binding protein (RBP). Eur J Cardiothorac Surg. 1999;15:717-721.

Wessel DL. Managing low cardiac output syndrome after congenital heart surgery. Crit Care Med. 2001;29:S220-S230.

Anestesia para correção de tetralogia de Fallot em paciente adulto: relato de caso

Anesthesia for repair of tetralogy of Fallot in an adult patient: case report

Michelle Nacur Lorentz; Bayard Gontijo Filho

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