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Anesthetic management in untreated Bland-White-Garland syndrome: a case report and literature review

Authors Guo Q, Chen YJ, Huang H

Received 5 January 2019

Accepted for publication 27 June 2019

Published 16 July 2019 Volume 2019:12 Pages 2167—2176


Checked for plagiarism Yes

Review by Single anonymous peer review

Peer reviewer comments 2

Editor who approved publication: Dr E Alfonso Romero-Sandoval

Qiao Guo, Yuan-Jing Chen, He Huang

Department of Anesthesiology, The Second Affiliated Hospital of Chongqing Medical University, Chongqing 400010, People’s Republic of China

Abstract: Bland-White-Garland syndrome (BWGS) is a rare congenital coronary artery malformation. In adult patients with BWGS, left coronary artery is supplied by collateral vessels from dilated right coronary artery. When high-pressure coronary flow drains into the low-pressure pulmonary artery with little ventricle perfusion, it causes a “coronary steal”. In this study, a 53-year-old man with untreated BWGS receiving choledochotomy under general anesthesia was presented. The patient suffered from chronic biliary calculi, atrial fibrillation, complete left bundle branch block, and chronic heart failure. The anesthetic management for choledochotomy in this patient presented a special challenge. Moreover, relevant literature search was performed for all the case reports of BWGS published in PubMed and MEDLINE from 1990 to 2018. In addition, a summary of underlying pathophysiology and anesthetic implications of patients with BWGS was provided.

Keywords: anesthesia, Bland-White-Garland syndrome, left main coronary artery, right coronary artery, pulmonary artery, coronary steal

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