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Case Reports
. 2017 Jan-Mar;11(1):89-92.
doi: 10.4103/1658-354X.197335.

Anesthetic management of a case of Gilbert's syndrome for mitral and aortic valve replacement: Role of transesophageal echocardiography

P S Nagaraja  1 , Naveen G Singh  1 , S Subash  1 , N Manjunatha  1 , C G Prabhushankar  1 , N Sathish  1
Affiliations
Case Reports

Anesthetic management of a case of Gilbert's syndrome for mitral and aortic valve replacement: Role of transesophageal echocardiography

P S Nagaraja et al. Saudi J Anaesth. 2017 Jan-Mar.

Abstract

Gilbert's syndrome (GS) is an autosomal inherited disorder characterized by relative deficiency of glucuronyl transferase and poor uptake of unconjugated bilirubin by hepatocytes. Cardiac surgery on cardiopulmonary bypass (CPB) in these patients triggers further hepatic dysfunction. Transesophageal echocardiography (TEE) and Doppler assessment of hepatic vein help in assessing hepatic blood flow (HBF) during cardiac surgery. Here, we discuss anesthetic management and role of TEE in maintaining HBF perioperatively in a 25-year-old male patient with GS undergoing double valve replacement with tricuspid valve plasty. TEE-guided HBF monitoring and management of hepatic perfusion by modifying anesthetic and CPB protocol resulted in the favorable outcome.

Keywords: Bilirubin; Gilbert syndrome; general anesthesia; transesophageal echocardiography.

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Conflict of interest statement

There are no conflicts of interest.

Figures

Figure 1
Figure 1
Transesophageal echocardiography estimation of hepatic blood flow. (a) Hepatic vein diameter, (b) pulse wave Doppler of hepatic blood flow off cardiopulmonary bypass, (c) pulse wave Doppler of hepatic blood flow on cardiopulmonary bypass
See this image and copyright information in PMC

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