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ABSTRACT
INTRODUCTION
Single Ventricle Heart is a rare and complex congenital heart disease. Congenital
heart disease occurs in 0.8% of newborns. Half of patients with congenital heart
disease who undergo heart surgery procedures are fertile age women. 1 The incidence
rate of Single Ventricle Heart disease is 3.2% of all incidents of congenital heart
disease.2 Patients with Single Ventricle Heart disease require special attention in
anaesthetic procedures due to a physiological change in the patient. We report
anaesthetic management in a woman after BCPS (Bidirectional Cavo-Pulmonary
Shunt) who undergoes curettage procedure. We will discuss the details of patient's
condition with Single Ventricle Heart and anaesthetic management in the patient.
CASE
DISCUSSION
Bidirectional Cavo-Pulmonary Shunt (BCPS) or commonly referred as Bidirectional
Glenn Procedure or Partial Fontan is a procedure of transferring blood flow from
Vena Cava Superior which initially leads to the right atrium into the right pulmonary
artery. In BCPS, Vena Cava Superior is grafted with the right pulmonary artery so
that blood from the upper extremity goes directly to the pulmonary arteries without
passing through the heart chambers.
The purpose of the BCPS procedure is to reduce cardiac burden in patients with
Single Ventricle Heart disease and increase oxygen saturation compared to the BCPS
preoperative conditions. BCPS is also performed to prepare the heart for a Fontan
procedure by lowering pulmonary blood pressure.
In this patient, a termination was performed, due to in pregnancy the preload increase
by 20-30%. In this patient the new cavopulmoner shunting is done on the Superior
Vena Cava, while the Inferior Vena Cava still connects to the right atrium, thus
increasing the preload load in these patients will also increase the risk of pulmonary
hypertension. Patients with oxygen saturation rate at rest less than 85% also increases
the probability of fetal death.
The anesthetic chosen in the patient was to use low-dose anesthesia 5 mg of
bupivacaine heavy. The use of low-dose neuraxial anesthesia can provide adequate
analgesia without much effect on hemodynamic changes, where hemodynamic
stability is an important factor in patients with cyanotic heart disease. Provision of
low-dose neuraxial anesthesia has a short duration, but it is not a problem in this
patient because the operation was performed in 10 minutes.