Critical Care Medicine-Neurologic Disorders>>>>>Congenital Heart Disease in Adults
Question 3#

A 15-year-old male patient was admitted to the ICU with a diagnosis of stroke after he got some accidental air bubbles injection while receiving IV fluid resuscitation in the emergency department, where he was seen for a viral prodrome. The patient’s family mentions that he has a known cardiac condition from birth, even though they do not know the name. Accidental injection of air into a peripheral vein would be LEAST likely to result in arterial air embolism in the patient with which of the following anatomic cardiac defects?

a. Patent ductus arteriosus
b. ES
c. Teratology of Fallot
d. Pulmonary atresia with ventricular septal defect
e. Tricuspid atresia

Correct Answer is A

Comment:

Correct Answer: A

Patent ductus arteriosus (A) causes left to right shunting and, hence, has the least risk of causing arterial air embolism. The anesthetic management of patients with congenital heart disease requires thorough knowledge of the pathophysiology of the cardiac defect. They can be categorized into defects causing left to right intracardiac shunts (acyanotic) and right to left shunts (cyanotic). The common congenital heart defects that result in right to left shunting include tetralogy of Fallot(C), Ebstein malformation of the tricuspid valve, pulmonary atresia with a ventricular septal defect (D), ES (B), tricuspid atresia (E), and patent foramen ovale. Meticulous care must be taken to avoid infusion of air via intravenous solutions because this can lead to arterial air embolism. Patients with congenital defects that result in left to right intracardiac shunting, such as patent ductus arteriosus, are at minimal risk for arterial air embolism because blood flow through the shunt is primarily from the systemic to the pulmonary system.

References:

  1. Hopkins WE, Ochoa LL, Richardson GW, Trulock EP. Comparison of the hemodynamics and survival of adults with severe primary pulmonary hypertension or eisenmenger syndrome. J Heart Lung Transplant. 1996;15(1 Pt 1):100-105.
  2. Apitz C, Webb GD, Redington AN. Tetralogy of fallot. Lancet. 2009;374(9699):1462-1471.
  3. Blalock A, Taussig HB. The surgical treatment of malformations of the heart: in which there is pulmonary stenosis or pulmonary atresia. J Am Med Assoc. 1945;128(3):189-202.