Methodology Article
Emergency Aorto-Pulmonary Shunt Using Two IV Cannulas Technique: A Rapid Stabilization Technique for Cyanotic Spells in Tetralogy of Fallot Before Cardiopulmonary Bypass
Ajit Singh*
,
Puneet Sharma,
Vinay Malhotra,
Vishesh Sharma
Issue:
Volume 11, Issue 2, April 2025
Pages:
13-17
Received:
25 February 2025
Accepted:
11 March 2025
Published:
26 March 2025
Abstract: Perioperative cyanotic spells in Tetralogy of Fallot (TOF) patients during the initiation of surgery can lead to profound desaturation & hemodynamic unstability. These spells are characterized by acute desaturation due to increased right-to-left shunting, often triggered by anesthesia induction, stress, or changes in vascular resistance. In severe cases, standard medical management—including fluid boluses, vasopressors, and beta-blockers—may fail, necessitating urgent intervention to restore pulmonary blood flow or put patient immediately on cardiopulmonary bypass (CPB). We encountered such a scenario in a 5-year-old child scheduled for total correction of TOF. Preoperative imaging had revealed good-sized branch pulmonary arteries but significant right ventricular outflow tract (RVOT) obstruction at valvular level. Two large major aortopulmonary collateral arteries (MAPCAs) had been coiled preoperatively. During anesthesia induction, the child developed a severe cyanotic spell perioperatively, with saturations progressively dropping below 20%. Despite aggressive conventional management, including oxygenation, deep sedation, and vasoactive support, the spell remained refractory, and the patient’s condition deteriorated rapidly. These measures failed to improve oxygenation, and decision was taken to immediately put patient on CPB.Recognizing the urgency, we immediately performed an emergency sternotomy to put patient on CPB, but as setting up CPB would take several minutes, meanwhile we also tried to stabilise the child by rapidly restore pulmonary circulation with our innovative novel Two IV Cannula technique: inserting a 14F IV cannula into the ascending aorta and another 14F IV cannula into the distal pulmonary artery, then connecting them with a standard IV tubing connector. This setup created a temporary aorto-pulmonary shunt within few seconds, functionally resembling a Blalock-Taussig-Thomas (BTT) shunt, allowing blood to bypass the obstructed outflow tract and directly perfuse the pulmonary circulation. This simple yet life-saving maneuver resulted in an immediate and dramatic improvement in oxygenation/saturation within few seconds, providing crucial time for controlled CPB initiation. Within seconds, the patient’s oxygen saturation improved dramatically from 20% to 70%, and hemodynamic stability was restored and allowing a controlled transition to CPB. This rapid stabilization technique using IV cannula in perioperative spelling child provided crucial time for CPB initiation under controlled conditions. The IV cannulas were then removed, and the total correction was successfully performed with a transannular patch. This simple, easily replicable & innovative Two IV cannulas technique offers a life-saving bridge to CPB in cases of refractory cyanotic spells. It is easy to implement, requires minimal equipment, achieved in few seconds and can be performed by an assistant while the primary surgeon continues with CPB cannulation. This approach may be especially useful in resource-limited settings & serves as an effective interim measure to stabilize the patient until bypass is established.
Abstract: Perioperative cyanotic spells in Tetralogy of Fallot (TOF) patients during the initiation of surgery can lead to profound desaturation & hemodynamic unstability. These spells are characterized by acute desaturation due to increased right-to-left shunting, often triggered by anesthesia induction, stress, or changes in vascular resistance. In severe ...
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Research Article
Open-heart Surgery for Congenital Heart Diseases at the University Hospital of Tengandogo: Epidemiologic, Diagnostic, Therapeutic and Evolution Aspects
Adama Sawadogo*,
Youssouf Nare,
Yacouba Tamboura,
Marie José Madjidene,
Moussa Bazongo,
Nebepoua Hippolyte Some,
Issaka Zallé,
Alain Sanou,
Safietou Tiemtoré,
Lynda Compaoré,
Lassina Konaté,
Farid Belem,
Adama Sanou
Issue:
Volume 11, Issue 2, April 2025
Pages:
18-22
Received:
9 April 2025
Accepted:
22 April 2025
Published:
12 June 2025
DOI:
10.11648/j.ijcts.20251102.13
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Abstract: Introduction: Congenital heart diseases (CHD) consist of abnormalities in the structure of the heart and / or main blood vessels, which occur before birth; they represent the most common birth defects in newborns. The prognosis has improved over the years due to availability of echocardiogram and better access to medical, interventional and surgical treatment. The aim of this study was to report the first series of open-heart surgeries done for congenital heart diseases in Burkina Faso, West Africa. Methods: It consisted of descriptive cross-sectional study with retrospective data collection. The study included of the patient who underwent open-heart surgery for CHD in the department of thoracic and cardiovascular surgery at the university hospital of Tengando over a period of 32 months, from January 1, 2021 to August 31, 2023. Results: a total of 46 patients were enrolled in the study and the male sex was predominant. There was no prenatal diagnosis and most of the CHD were discovered late. Recurrent bronco-pneumopathy was the most previous medical condition. All patients presented with dyspnea. Patients were operated under general anesthesia with invasive monitoring. Thorax was open by a median sternotomy. CHD included 31 left-to-right shunts (67.4%), 12 cyanotic CHD (26.1%) and 2 cases of obstructive CHD (4.3%). Right atriotomy was the approach used to close all atrial septal defects (ASD) and isolated ventricular septal defects (VSD). In the 11 cases of tetralogy of the study, 9 cases repaired with a conservation of the pulmonary valve. Average cardiopulmonary bypass time and aortic cross clamping were respectively 93.2 ± 38 minutes and 56.9 ± 27.8 minutes. Postoperative was uneventful in 42 patients (91.3%). Four patients presented complications that included bleeding in two cases. The mortality was nil. Conclusion: the majority of the patients were grown up and symptomatic children who were diagnosed late with the CHD. Although the surgeries were performed late, early results were satisfactory. The current challenge is to perform more surgery and progressively lower down the weight of the babies who undergo open-heart surgery for CHD in Burkina Faso.
Abstract: Introduction: Congenital heart diseases (CHD) consist of abnormalities in the structure of the heart and / or main blood vessels, which occur before birth; they represent the most common birth defects in newborns. The prognosis has improved over the years due to availability of echocardiogram and better access to medical, interventional and surgica...
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