# Anesthesia management of laparoscopic right colectomy in an older patient with postoperative tetralogy of Fallot with residual anomaly

## TL;DR

This case report discusses the successful laparoscopic surgery in an older patient with a repaired tetralogy of Fallot and residual heart issues.

## Contribution

The study provides a rare case report on anesthetic management for laparoscopic surgery in an adult with repaired tetralogy of Fallot and residual anomaly.

## Key findings

- Laparoscopic surgery was well-tolerated in a patient with repaired tetralogy of Fallot and residual ventricular septal defect.
- Positive pressure ventilation and insufflation reduced left-to-right ventricular shunting and normalized the Qp/Qs ratio.
- Patients with preserved right ventricular function and low pulmonary vascular resistance may tolerate laparoscopic surgery.

## Abstract

Diversity in hemodynamics of adult congenital heart disease necessitates a case-by-case selection of appropriate surgical and anesthetic options. However, previous case reports regarding the management of laparoscopic surgery in adult patients with congenital heart disease are limited.

A 72-year-old man who underwent a laparoscopic right colectomy for colon cancer had a residual ventricular septal defect and right ventricular outflow tract obstruction despite post-repair of tetralogy of Fallot. Pulmonary hypertension or right ventricular dysfunction was not observed. The preoperative pulmonary to systemic blood flow ratio (Qp/Qs) was 2.3. After positive pressure ventilation and insufflation, the amount of left-to-right ventricular shunting decreased, and the Qp/Qs approached 1.0, as calculated from pulmonary arterial and systemic arterial blood gas analysis.

Laparoscopic surgery might be tolerable in patients with tetralogy of Fallot who have preserved the right ventricular function, left-to-right ventricular shunting, and no high pulmonary vascular resistance.