Shahab Naqvi, Rashad Siddiqi.
Peri-operative management of adult Tetralogy of Fallot
Pak Armed Forces Med J Sep 2006;56(3):316-8.
Combined Military Hospital Bahawalpur

A 31-years old married soldier, weighing 57 Kg, was referred with a history of shortness of breath associated with chest pain since childhood that had increased over the last 3 years. He experienced dyspnea on mild to moderate exertion (NYHA - III). He was onoral propanolol 10mg thrice daily. On preoperative investigations, his haemoglobin was 20.2 Gm/ dL with 0.56 haematocrit. Echocardiography showed a patent foramen ovale, big ventricular septal defect, a 50% aortic over-ride with a right ventricular outflow tract obstruction and a pressure gradient of 80mmHg. Pre-operative chest radiograph revealed a hypertrophied right ventricle with oligaemic lungs. Oral premedication with benzodiazepine on the night before surgery and narcotic-based intra-muscular premedication was given before surgery. On arrival in the operation theatre, he had a regular pulse rate of 105 per minute, blood pressure 145/100mmHg and arterial oxygen saturation of 91-92% on air. Anesthetic management included ketamine-based induction technique with endotracheal intubation and positive pressure ventilation with enflurane in Oxygen. Intra-arterial and central venous pressures were monitored along with arterial gas analyses. Aprotonin was given by slow intravenous bolus followed by 1,000,000 KIU in an infusion. St. Thomas` Crystalloid Cardioplegic Solution was used during the Cardio Pulmonary Bypass (CPB). Triglycerine infusion was used, in addition to the warming blanket, during re-warming. Low dose adrenaline infusion was started before the patient was attempted to be weaned-off from CPB. On coming smoothly off-bypass, patient started showing ventricular premature contractions (VPCs) that were treated with an intravenous bolus of Lignocaine 1.5mg/Kg that had to be followed by an infusion 0315µg/Kg/min. He was shifted to the post-operative surgical ICU with continued mechanical ventilation.

Category: Case Reports
Keywords: Fallot Tetralogy. Congenital Heart Disease.

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