Management of Non-cardiac Surgery in an Elderly Patient with Uncorrected Double Inlet Left Ventricle: Utility of the Pulse Contour Analysis-Based Cardiac Output Monitor

Double inlet left ventricle (DILV) is a rare congenital heart disease that usually requires surgical treatment in childhood but can survive to old age untreated under certain conditions. In such patients, general anesthesia management requires an understanding of their unique hemodynamics and pathophysiology, along with the ability to maintain these conditions. In this case, long-term survival was possible due to the maintenance of an appropriate pulmonary-systemic blood flow balance achieved by pulmonary artery stenosis (PS), necessitating anesthesia management that preserved this balance. We report a case of non-cardiac anesthesia in an untreated adult patient with DILV, where systemic vascular resistance (SVR) monitoring and anesthesia management using remimazolam were employed to maintain stable circulatory control.