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

Satori Mori; Hisakatsu Ito; Sadamu Sugimoto; Daisuke Hibi; Akiyo Kameyama; Masaaki Kawakami; Tomonori Takazawa

doi:10.1186/s40981-024-00707-2

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

JA Clin Rep. 2024 Apr 11;10(1):24. doi: 10.1186/s40981-024-00707-2.

Authors

Satori Mori¹, Hisakatsu Ito², Sadamu Sugimoto¹, Daisuke Hibi¹, Akiyo Kameyama³, Masaaki Kawakami¹, Tomonori Takazawa¹

Affiliations

¹ Department of Anesthesiology, University of Toyama, Sugitani 2630, Toyama, Toyama, 930-0194, Japan.
² Department of Anesthesiology, University of Toyama, Sugitani 2630, Toyama, Toyama, 930-0194, Japan. hisa@med.u-toyama.ac.jp.
³ Department of Anesthesiology, Kurobe City Hospital, Mikkaiti 1108-1, Kurobe, Toyama, 938-8502, Japan.

Abstract

Background: 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.

Case presentation: 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.

Conclusions: 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.

Keywords: Laparoscopic surgery; Non-cardiac surgery; Pulmonary to systemic blood flow ratio; Tetralogy of Fallot.