Award Papers / ISH Narani Best Poster Award
The Anaesthetic Management And Physiological Implications In Adult Patient With Alcapa: For A Non Cardiac Surgery
Dr.Jafra A, Dr.Arora S,Dr. Sunita K and Dr.Jayant A
The anomalous origin of left coronary artery from pulmonary artery is a rare congenital
coronary anomaly accounting for 0.24% of congenital heart diseases. Most infants
die within first year of life. 10-20% of patients remain asymptomatic and survives
to adulthood. Survival beyond infancy depends on development of adequate
collaterals. We present a case of incidentally detected ALCAPA in a cardiac patient
who presented for non cardiac surgery. The patient was posted for a laparoscopic
cholecystectomy, urgently indicated in view of a past episode of gallstone pancreatitis.
We describe the anesthetic management and the goals to maintain such patient’s
perioperatively. Maintenance of adequate coronary perfusion is key in the
management of ALCAPA patient presenting for cardiac or non cardiac surgery.
Goals in anesthetic management includes to maintain systemic oxygenation, prevent
increase in myocardial oxygen demand, maintain normal SVR, avoid fall in PVR
which can cause coronary steal and optimize systemic venous oxygen tension as
a surrogate of cardiac output. The role of perioperative ECHO in detecting volume
status as also changes in contractility and the measurement of biomarkers to detect
occult myocardial damage is also topical. We discuss some of these aspects including
the choices for laparoscopic vs. Open intervention and the aspects of anesthetic
management for laparoscopy pertinent to this case besides making the pitch for wider
availability and training in perioperative ECHO.