PULMONARY ATRESIA WITH VENTRICULAR SEPTAL-DEFECT - A CASE FOR CENTRALVENOUS-PRESSURE AND OXYGEN-SATURATION MONITORING

A 21-year-old patient with pulmonary atresia and ventricular septal de fect (PA-VSD) was admitted to the hospital for tubal ligation. Invasiv e arterial and central venous (CVP) pressure, pulse oximetric oxygen s aturation(SpO2), and (from the tip of oximetric central venous cathete r) central venous oxygen saturation (ScvO2) and oxygen extraction rate (ExO2) were continuously monitored. Heart rate (range: 68-75 beat/min ), mean arterial pressure (80-90 mmHg), CVP (7-10 mmHg), SpO2 (79-90 p ercent), ScvO2 (57-70 percent), and ExO2 (21-30 percent) remained stab le during epidural anesthesia and transvaginal sterilization. Followin g an overnight stay (peak SpO2 92 percent; peak ScvO2 71 percent; trou gh ExO2 21 percent), the oxygen data returned to baseline on awakening (SpO2 <80 percent, ScvO2 <55 percent, ExO2 >35 percent), and the pati ent was discharged. In PA-VSD, a single-outlet double-ventricle anomal y, CVP reflects the preload of systemic ventricle. As the mixed venous oxygen saturation cannot be defined, ScvO2 is the best available indi cator of the whole body oxygen consumption. Continuous monitoring of C VP, ScvO2 and ExO2 in the superior vena cava may provide more insight into the response to anesthesia and surgery in patients with PA-VSD.