Transposition Of Great Arteries With Ventricular Septal Defect and Dextrocardia:

A Non Cardiac Surgery Case Report

Hidayat, Muchammad. Erias Erlangga, Iwan Fuadi

Department of Anesthesiolgy and Intensive Care

Padjadjaran University Faculty of Medicine - Hasan Sadikin General Hospital, Bandung

Background: Transposition of Great Arteries (TGA) is the second most common type
of cyanotic congenital heart disease. TGA found in 5-7% of all congenital heart
disease and incidence is 1: 3,500 – 5,000 live births. The most common comorbid
abnormality is ventricular septal defect (VSD). TGA with VSD creates parallel
circulation systems in which recirculation of oxygenated blood occurs within the
pulmonary circuit via the left ventricle and pulmonary trunk while deoxygenated
systemic blood recirculates to the body via the right ventricle and aorta that result in
systemic cyanosis.

Case Report: A 4-year-old girl came for mouth preparation for TGA correction
surgery. Patient has history of cyanotic since infancy, SpO2 80-85%, murmur systolic,
and clubbing fingers. Echocardiography found abnormalities of TGA, dektrocardia, and
VSD. Patient assessed ASA III and performed general anesthesia. Patient was
preoxygenated, then induced by midazolam, fentanyl and atracurium and intubation
with endotracheal tube number 4.5. Maintenance of anesthesia are O2, air, and
sevoflurane. Intraoperative dan post operative hemodynamic was stable. Patient
extubated fully awake and analgetic post operative is paracetamol.

Discussion: Management of anesthesia are preventing decrease cardiac output and

Systemic Vascular Resistance (SVR), and to keep Pulmonary Vascular Resistance
(PVR) lower than SVR. Hypoxia, systemic hypoxemia, metabolic acidosis, hypercarbia
and sympathetic nervous system stimulation due to light plane of anesthesia and pain
can trigger a rapid rise in PVR. Opioid base has excellent cardiovascular stability
properties. Hypercyanotic spell management are increase inspired oxygen, increase
volume, increase SVR and ceasing infundibular spasme.2,4,5

Conclusions: Successful anesthetic management are by prevent decrease cardiac

output, SVR and keep PVR lower than SVR.

Keywords: Cyanotic congenital heart disease, pulmonary vascular resistance (PVR),

systemic vascular resistance (SVR), transposition of the great arteries (TGA).

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