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Anesthetic considerations during caval inflow occlusion in children with congenital heart disease

Kirsten C Odegard1, Annette Schure, Yoshikatsu Saiki

  • 1Department of Anesthesia, Children's Hospital, Boston, MA 02115, USA. kristen.odegard@tch.harvard.edu

Journal of Cardiothoracic and Vascular Anesthesia
|April 10, 2004
PubMed

Insights

Caval inflow occlusion (IO) is effective for atrial septectomy without cardiopulmonary bypass (CPB). Careful anesthetic management is crucial due to potential hemodynamic instability and complications in pediatric cardiac surgery.

Area of Science:

  • Pediatric Cardiac Surgery
  • Congenital Heart Defects
  • Anesthesiology

Background:

  • Caval inflow occlusion (IO) facilitates pulmonary and aortic valvotomy without cardiopulmonary bypass (CPB).
  • This technique is infrequently used but valuable for complex single-ventricle congenital heart defects requiring atrial septectomy.
  • Complications and anesthetic considerations of IO have not been previously described.

Purpose of the Study:

  • To describe the potential complications and anesthetic considerations associated with caval inflow occlusion (IO) for atrial septectomy.
  • To evaluate the efficacy and safety of IO in pediatric patients with complex congenital cardiac defects.

Main Methods:

  • Retrospective review of 11 pediatric patients undergoing atrial septectomy with IO.
  • Median age of patients was 3 months (range 3 days-3 years).
  • Mean duration of IO was 87.7 seconds.

Main Results:

  • One intraoperative death (9%) occurred.
  • 7 of 11 patients required inotropic support post-IO.
  • 4 of 11 patients experienced arrhythmias, and 10 required blood transfusions and circulatory support.
  • 91% of patients survived to discharge with a mean ICU stay of 3.7 days.

Conclusions:

  • Caval inflow occlusion (IO) is an effective technique for short intracardiac procedures, avoiding cardiopulmonary bypass (CPB).
  • Close collaboration between anesthesia and surgical teams is essential to minimize IO duration and manage potential hemodynamic instability.
  • The technique is associated with significant but manageable complications in this pediatric cohort.
Abstract

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