# The Risk of Hemorrhage and Shunt Occlusion After Tonsillectomy in a Glenn Circulation Patient With Blalock-Taussig Shunt Dependence: A Case Report

## TL;DR

This case report discusses the challenges of performing a tonsillectomy on a child with congenital heart disease, focusing on the risks of bleeding and shunt occlusion.

## Contribution

The paper presents a novel case highlighting the trade-off between preventing postoperative hemorrhage and the risk of shunt occlusion in a Glenn circulation patient.

## Key findings

- Discontinuing anticoagulants reduced postoperative bleeding risk but may have caused shunt occlusion.
- Restarting anticoagulation therapy was delayed until postoperative day 15 due to wound healing concerns.
- The case suggests the need for more attention to thrombosis risk in similar patients.

## Abstract

Tonsillectomy is among the most common procedures performed on children. Children with congenital heart disease sometimes undergo tonsillectomy to reduce pulmonary arterial pressure. These children can have low cardiac function and low oxygen saturation (SpO2) and pose particular challenges to the anesthesia team. In this article, we report our experience of anesthetic management of a child with post-Glenn procedure and Blalock-Taussig shunt dependence who underwent a tonsillectomy. To avoid postoperative hemorrhage, anti-coagulants/anti-platelets were discontinued five days before surgery. After discontinuation of these medications, we administered heparin until five hours before surgery. Anti-coagulants/anti-platelet medications were resumed on postoperative day 15 when epithelialization of the surgical wound was achieved. This strict management helped avoid hemorrhage but may have induced the subsequent postoperative Blalock-Taussig shunt embolic occlusion, which required reconstruction. In our case, we gave priority to the prevention of postoperative hemorrhage and delayed the restart of anticoagulation therapy, although we now believe that the risk of thrombosis should be given more attention and anticoagulation treatment should be restarted as soon as possible.