Anesthetic Management for Atrial Septal Defect Closure in a Patient with Bidirectional Shunt and Pulmonary Hypertension

Abstract

<p><strong>Background </strong>: ASD bidirectional shunt occurs when flow moves between left and right depending on the higher pressure, either systemic vascular resistance (SVR) or pulmonary vascular resistance (PVR). The anesthetic management aimed to maintain the left-to-right shunt and control factors that could increase PVR while retaining SVR within normal or slightly elevated ranges.</p><p><strong>Case Illustration </strong>: We reported a 39-year-old female patient with ASD, bidirectional shunt, and pulmonary hypertension (PH) who underwent defect closure. Due to the mean pulmonary pressure exceeded 50% of mean systemic pressure, an intentional ASD creation was performed. It is not a routine procedure; however, it serves as a “way out” if there is severe left ventricular dysfunction. Attention and intervention were promptly administered for any identified post-surgical issues, including PH crisis or right ventricular dysfunction. The management of PH was conducted during perioperative period and the patient was successfully extubated at 17 hours post-surgery.</p><p><strong>Conclusion </strong>: Perioperative management of bidirectional shun ASD with PH requires a SVR and PVR. Factors that can increase PVR must be avoided/controlled and on the other hand SVR must be maintained.</p>