Successful Anesthetic Management of Video-Assisted Thoracic Surgery in a Patient With Cardiac Complications After Arterial Switch Operation

TL;DR

This case study describes successful anesthetic management during a thoracic surgery in a patient with prior heart surgery complications.

Contribution

The paper presents a novel case report on anesthetic management using one-lung ventilation in a patient with post-arterial switch cardiac complications.

Findings

The patient's hemodynamics and oxygenation were well maintained during one-lung ventilation.

Non-stenotic left pulmonary artery was crucial for successful ventilation.

Multimodal evaluation is important for managing long-term cardiac complications after arterial switch operations.

Abstract

The arterial switch operation with the Lecompte maneuver has become the therapy of choice for dextro-transposition of the great arteries, contributing to the improved survival rate of patients. Nevertheless, there have been few case reports addressing anesthetic management using one-lung ventilation in patients with an arterial switch. A 24-year-old man who underwent an arterial switch operation at 10 days of age was admitted for a right spontaneous pneumothorax. Preoperative transthoracic echocardiography revealed significant neo-aortic regurgitation, tricuspid regurgitation, and estimated right ventricular systolic pressure at the upper normal limit, all of which can be observed after the procedure. The pulmonic valve and pulmonary artery were difficult to delineate by transthoracic echocardiography. Instead, a plain CT demonstrated non-stenotic pulmonary arteries. During left isolated ventilation in the lateral decubitus position, the patient's hemodynamics and oxygenation were both well maintained, and a right thoracoscopic bullectomy was performed uneventfully under total intravenous anesthesia with propofol and remifentanil. Vital signs were also stable postoperatively, and the patient was discharged on the fifth postoperative day without adverse cardiovascular events. In the present case, the non-stenotic left pulmonary artery was considered to have played a vital role in successful one-lung ventilation, highlighting the importance of multimodal evaluation for long-term cardiac complications in a patient who underwent an arterial switch operation.

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