Perioperative Management of a Toddler With Tuberous Sclerosis and Dilated Cardiomyopathy Undergoing Open Abdominal Aortic Aneurysm Repair: A Case Report

Toddler abdominal aortic aneurysms (AAA) are rare and lack defined perioperative guidelines. Aneurysms may be associated with tuberous sclerosis complex (TSC) but rarely occur with concurrent dilated cardiomyopathy. This case report describes the anesthetic and surgical considerations for a two-year-old male with TSC and dilated cardiomyopathy with low ejection fraction undergoing open infrarenal AAA repair. Our most important perioperative considerations included advanced hemodynamic monitoring, management of intraoperative blood loss, and the physiological changes associated with aortic clamping. Transesophageal echocardiography was used throughout the operation to guide inotropic support and assess ventricular filling using renal-protective strategies and balanced transfusion.