Anesthetic Implications for Cesarean Section in a Parturient with Complex Congenital Cyanotic Heart Disease

Abstract

The discordance between increased physiological demand during pregnancy and congenital cardiac pathology of a parturient is a perilous threat to the maternal-fetal well-being. Early involvement of a multidisciplinary team is essential in improving peripartum morbidity and mortality. Designing the most appropriate anesthetic care will require a concerted effort, with inputs from the obstetricians, obstetric and cardiac anesthesiologists, cardiologists, neonatologists, and cardiothoracic surgeons. We report the multidisciplinary peripartum care and anesthetic management for cesarean section (CS) of a 28-year-old primigravida who has partially corrected transposition of the great arteries, atrial and ventricular septal defect, dextrocardia, right ventricle hypoplasia, and tricuspid atresia.

Pregnancy Management in a Patient With Congenital Heart Disease and Severe Right Ventricle to Pulmonary Artery Conduit Stenosis

“… 18 Benefits of general anesthesia include the avoidance of profound sympathetic block, commonly seen in spinal and epidural techniques, and the ability to concomitantly use transesophageal echocardiography. 19 Regional (epidural and spinal) anesthesia preserves the mother's baseline ventilation and perfusion state. Epidural anesthesia also allows for continuous anesthetic and analgesic infusion, allowing for adjustment during delivery to minimize pain.…”