Anesthetic management of a pregnant patient with congenitally corrected transposition of the great arteries for labor and vaginal delivery

A retrospective survey of adverse maternal and neonatal outcomes for parturients with congenital heart disease

“…7 Our study is the largest series in the literature focusing on method of anesthesia for parturients with congenital heart disease. Although anecdotal case reports of anesthetic regimens for pregnant women with specific types of congenital heart disease are available, [10][11][12] no agreement exists on the optimal anesthetic management technique for maternal and neonatal outcomes. Recently, an extensive review article was published to provide a practical guide to the anesthetic management of pregnant women with congenital heart disease.…”

Anesthetic management of labor in a patient with congenitally corrected transposition of the great arteries

“…Patients traditionally present with heart failure or heart block. 2 Other common presenting characteristics include bradycardia, single loud second heart sound often palpable to the left of the sternum (due to an anterior positioned aortic valve), heart murmur, cyanosis, and tachyarrhythmia. 1 Several tools can be employed in the diagnosis of C-TGA.…”

“…2 This is superior to transthoracic echocardiogram due the ability of TEE to assess the longitudinal plane to study ventriculoarterial connections. 2 Detection of this anomaly can be complicated by the fact that the morphological right ventricle is on the patient's left and can easily be mistaken for the morphological left ventricle due to its trabeculations. 1 Evaluation includes detecting the tricuspid valve, which always enters the morphological right ventricle, by noting that it is more inferior (closer to the cardiac apex) than the mitral valve.…”

“…1,2 The disease is characterized by two main features, left-handed looping of the heart resulting in atrioventricular discordance (ventricular inversion where the morphologically right ventricle is situated to the left of the morphologically left ventricle) and failure of the aortopulmonary septum to rotate 180 degrees causing ventriculo-arterial discordance (where the aorta arises from the right ventricle and the pulmonary artery arises from the left ventricle). 3 In effect, both the great vessels and the ventricles are transposed, thus the blood remains in a series as opposed to parallel circulation.…”

A functional understanding of moderate to complex congenital heart disease and the impact of pregnancy. Part I: The transposition complexes

“…27 These patients have two abnormalities that nearly correct each other in physiologic terms. They have ventriculo-arterial discordance (type 6, as in patients with classic transposition of the great arteries) but they also have atrio-ventricular discordance (type 3), which means they have a natural intra-atrial switch leaving them with an essentially normal circulation in terms of oxygenation (Fig.…”