REVIEW ARTICLE
Year : 2012  |  Volume : 6  |  Issue : 1  |  Page : 1-6

Truncus arteriosus ( perioperative management)


Department of Anesthesia and Critical Care, Aswan Heart Center, Aswan, Egypt

Correspondence Address:
Marie Bosman
MB, ChB, MMed Anes (SA) CESR (UK), Cardiac Anesthetist at Christiaan Barnard Memorial Hospital, Cape Town, South Africa

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Source of Support: None, Conflict of Interest: None


DOI: 10.7123/01.EJCA.0000418017.81412.ba

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Truncus arteriosus is a congenital cardiovascular anomaly characterized by a single arterial vessel (truncus) with one valve arising from the heart. The truncus overrides a large perimembranous ventricular septal defect and receives mixed blood from both ventricles and supplies blood to the pulmonary, systemic, and coronary circulation, the ratio of the bloodflow vary according to the different vascular resistances. The anomaly is divided into four types according to Collett and Edwards classification on the basis of the origin of the pulmonary arteries from the truncal artery. In truncus, the goal is to balance the circulation to obtain QP:QS = 1 to maintain reasonable oxygen saturation as well as adequate organ perfusion. Careful titration of anesthetic agents and careful monitoring of their hemodynamic effects and appropriate measures to adjust pulmonary (PVR) and systemic vascular (SVR) resistances and cardiac performance are probably more important than the selection of a particular anesthetic agent. Postoperatively, low cardiac output can be expected because of high PVR and right ventricular failure. High PVR, both sustained and paroxysmal, should be anticipated. Pulmonary hypertensive crisis presents as low cardiac output and right ventricular failure. Avoidance of these potentially fatal events is essential to decrease the mortality and morbidity associated with repair. Events that trigger a hypertensive crisis, such as hypoxia, hypercapnia, acidosis, pain, airway stimulation, and left ventricular failure, must be avoided.



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