Aims
Atrial septal defects (ASD) are present in about 1 in 1,500 children at birth and account for 30% to 40% of congenital heart disease in adults. ASD closure is usually performed for the prevention of stroke or right ventricular volume overload and pulmonary hypertension. Current American Heart Association guidelines recommend closure of ASDs for right atrial or right ventricular enlargement, paradoxic embolism, documented orthodeoxiaplatypnea and pulmonary hypertension. ASD closure results in symptomatic improvement and reductions in right ventricular size and pulmonary arterial pressures at any age. We report the anesthetic management of percutaneous ASD closure in childhood.
Case
The patient was a 4 year-old, 16 kg, girl, scheduled for ASD closure. Preoperative physical examination other than cardiac auscultation was normal and vital signs were unremarkable. Because of the procedure was made with TEE guidance, we decided to intubate the patient. Patient was monitored with 5 lead ECG, pulse oxymeter, non-invasive blood pressure. Anesthesia was induced with %2-8 sevoflurane with facemask and then i.v. propofol 2mg/kg, fentanyl 1mcg/kg, rocuronium 0.6mg/kg; and maintained with sevoflurane inhalation with mixture of %50 air-oxygen combination. Lungs were ventilated with tidal volume 6-8 ml/kg and a respiratory rate of 16 per minute. TEE was inserted after induction and heparin was given to maintain an activated coagulation time (ACT) >200 seconds. Procedure was uneventful and after procedure she was extubated and transferred to cardiac intensive care unit.
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