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A 3-year-old boy was admitted to the hospital due to a recent exacerbation of cyanosis around the lips. Echocardiography showed complete transposition of the great arteries (TGA) with ventricular septal defect (VSD) and ventricular outflow tract obstruction (LVOTO). He was scheduled to undergo Nikaidoh under general anesthesia. The anatomical abnormalities related to coronary insufficiency and the mismatch of the ventricle and aortic resistance related to low cardiac output syndrome occurred after surgery. The boy’s hemodynamics were stabilized after decompression of the coronary artery by reoperation and ECMO-assisted circulation. The anesthetic management before cardiopulmonary bypass (CPB) should focus on balancing the pulmonary-to-systemic flow ratio (Qp/Qs) by adjusting the systemic-to-pulmonary vascular resistance ratio (SVR/PVR). After CPB, the anesthetic management should focus on assessing and treating coronary perfusion and myocardial contractile function.

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Anesthetic Management of Nikaidoh Surgery in a Child with Complete Transposition of the Great Arteries

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  • 发表日期：

    2025年

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  • Chi Wu

摘要

A 3-year-old boy was admitted to the hospital due to a recent exacerbation of cyanosis around the lips. Echocardiography showed complete transposition of the great arteries (TGA) with ventricular septal defect (VSD) and ventricular outflow tract obstruction (LVOTO). He was scheduled to undergo Nikaidoh under general anesthesia. The anatomical abnormalities related to coronary insufficiency and the mismatch of the ventricle and aortic resistance related to low cardiac output syndrome occurred after surgery. The boy’s hemodynamics were stabilized after decompression of the coronary artery by reoperation and ECMO-assisted circulation. The anesthetic management before cardiopulmonary bypass (CPB) should focus on balancing the pulmonary-to-systemic flow ratio (Qp/Qs) by adjusting the systemic-to-pulmonary vascular resistance ratio (SVR/PVR). After CPB, the anesthetic management should focus on assessing and treating coronary perfusion and myocardial contractile function.