Tetralogy of Fallot/Pulmonary Atresia/Major Aortopulmonary Collateral Arteries - Revision history

Christopher.Deeble: added info

2024-05-04T19:21:19Z

added info

← Older revision		Revision as of 12:21, 4 May 2024
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	Major aortopulmonary collateral arteries (MAPCAs) are present in 20-25% of patients with Tetralogy of Fallot plus pulmonary atresia.		Major aortopulmonary collateral arteries (MAPCAs) are present in 20-25% of patients with Tetralogy of Fallot plus pulmonary atresia. Overall condition of TOF/PA/MAPCAs incidence of 0.7 per 10,000 live births. Associated DiGeorge syndrome (22q11 deletion) in >35% of patients. Oxygenation dependent on ratio of pulmonary to systemic blood flow (Qp/Qs). Often undergo a single complete repair vs. a staged repair.

	== Anesthetic implications<!-- Briefly summarize the anesthetic implications of this comorbidity. --> ==		== Anesthetic implications<!-- Briefly summarize the anesthetic implications of this comorbidity. --> ==

	=== Preoperative optimization<!-- Describe how this comorbidity may influence preoperative evaluation and optimization of patients. --> ===		=== Preoperative optimization<!-- Describe how this comorbidity may influence preoperative evaluation and optimization of patients. --> ===
			Basic laboratory data including CBC with differential, basic metabolic panel, and coagulation studies. ECG, chest X-ray. Recent (within 6 months) transthoracic echocardiography. Cardiac catheterization with angiography with characterization of MAPCAs. Review prior cardiac catheterization anesthetic record for hemodynamic instability or desaturations, which may be an indication of MAPCA spasms (can occur again during surgical dissection).

	=== Intraoperative management<!-- Describe how this comorbidity may influence intraoperative management. --> ===		=== Intraoperative management<!-- Describe how this comorbidity may influence intraoperative management. --> ===
			Most patients can safely undergo inhalational induction with sevoflurane (except those with congestive heart failure or extreme cyanosis). Adjust FiO2 to maintain oxygen saturation 75-85% (balanced Qp/Qs). DiGeorge patients may prove more difficult to intubate.

			Patients may have tortuous peripheral veins. Due to large potential blood loss, recommend 2 large peripheral IVs for patients having initial surgery; for patients with prior sternotomies or thoracotomies, recommend single lumen introducer and rapid blood product infuser. Additionally, placement of RIJ CVC for CVP monitoring. Try to save femoral veins for future cardiac catheterization procedure, however, can use if need more access. Arterial access in a radial artery for blood pressure monitoring and obtaining blood gas samples. May consider a femoral artery catheter if concerned about accurate blood pressure waveform; alternatively, can request surgeon connect pressure tubing to arterial bypass cannula to transduce aorta (temporary until recovery of radial waveform).

			To avoid drops in systemic blood pressure, avoid inhaled anesthetic agents after induction. Maintenance with TIVA: various combinations of infusions of fentanyl, midazolam, ketamine, or dexmedetomidine with a longer acting nondepolarizing neuromuscular blocker infusion. Tend to avoid propofol due to risk of interfering with cardiopulmonary bypass oxygenator, or concern of metabolic acidosis.

			Dissection around MAPCAs with large contributions to pulmonary blood flow may lead to desaturations and metabolic acidosis. Usually done off CPB if tolerated.

	=== Postoperative management<!-- Describe how this comorbidity may influence postoperative management. --> ===		=== Postoperative management<!-- Describe how this comorbidity may influence postoperative management. --> ===
			Transfer to CVICU intubated for continued monitoring and resuscitation/repletion of blood products.

	== Related surgical procedures<!-- List and briefly describe any procedures which may be performed specifically to treat this comorbidity or its sequelae. If none, this section may be removed. --> ==		== Related surgical procedures<!-- List and briefly describe any procedures which may be performed specifically to treat this comorbidity or its sequelae. If none, this section may be removed. --> ==
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	== Pathophysiology<!-- Describe the pathophysiology of this comorbidity. Add subsections as needed. --> ==		== Pathophysiology<!-- Describe the pathophysiology of this comorbidity. Add subsections as needed. --> ==
			Oxygenation dependent on ratio of pulmonary to systemic blood flow (Qp/Qs). MAPCA morphology can be a large determinant of this balance of blood flows. Large unobstructed MAPCAs can lead to adequate oxygenation but over-circulation due to unrestricted pulmonary blood flow, which may cause heart failure. Stenotic or tortuous MAPCAs lead to restricted pulmonary blood flow with limited oxygenation, but seldom to cause heart failure.

	== Signs and symptoms<!-- Describe the signs and symptoms of this comorbidity. --> ==		== Signs and symptoms<!-- Describe the signs and symptoms of this comorbidity. --> ==
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	== Epidemiology<!-- Describe the epidemiology of this comorbidity --> ==		== Epidemiology<!-- Describe the epidemiology of this comorbidity --> ==
			Overall condition of TOF/PA/MAPCAs incidence of 0.7 per 10,000 live births. Associated DiGeorge syndrome (22q11 deletion) in >35% of patients.

	== References ==		== References ==

	[[Category:Comorbidities]]		[[Category:Comorbidities]]

Christopher.Deeble at 21:31, 1 June 2023

2023-06-01T21:31:27Z

← Older revision		Revision as of 14:31, 1 June 2023
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	== Related surgical procedures<!-- List and briefly describe any procedures which may be performed specifically to treat this comorbidity or its sequelae. If none, this section may be removed. --> ==		== Related surgical procedures<!-- List and briefly describe any procedures which may be performed specifically to treat this comorbidity or its sequelae. If none, this section may be removed. --> ==
			Cardiac catheterization lab procedures after surgical repairs: branch PA stenosis ballooning, Melody or Harmony valves

	== Pathophysiology<!-- Describe the pathophysiology of this comorbidity. Add subsections as needed. --> ==		== Pathophysiology<!-- Describe the pathophysiology of this comorbidity. Add subsections as needed. --> ==

Christopher.Deeble: added details

2023-06-01T21:25:59Z

added details

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-Provide a brief summary of this comorbidity here.
+Major aortopulmonary collateral arteries (MAPCAs) are present in 20-25% of patients with Tetralogy of Fallot plus pulmonary atresia.
 == Anesthetic implications<!-- Briefly summarize the anesthetic implications of this comorbidity. --> ==
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 == Diagnosis<!-- Describe how this comorbidity is diagnosed. --> ==
 == Treatment<!-- Summarize the treatment of this comorbidity. Add subsections as needed. --> ==
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 === Surgery<!-- Describe surgical procedures used to treat this comorbidity. --> ===
 === Prognosis<!-- Describe the prognosis of this comorbidity --> ===

Christopher.Deeble: created page

2023-06-01T20:32:05Z

created page

New page

{{Infobox comorbidity
| other_names =
| anesthetic_relevance =
| specialty =
| signs_symptoms =
| diagnosis =
| treatment =
| image =
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}}

Provide a brief summary of this comorbidity here.

== Anesthetic implications ==

=== Preoperative optimization ===

=== Intraoperative management ===

=== Postoperative management ===

== Related surgical procedures ==

== Pathophysiology ==

== Signs and symptoms ==

== Diagnosis ==

== Treatment ==

=== Medication ===

=== Surgery ===

=== Prognosis ===

== Epidemiology ==

== References ==

[[Category:Comorbidities]]