Epidural anesthesia for a cesarean section in a patient with pulmonary atresia and ventricular septal defect

doi:10.1016/0952-8180(91)90184-O

Journal of Clinical Anesthesia

Volume 3, Issue 5, September–October 1991, Pages 399-402

https://doi.org/10.1016/0952-8180(91)90184-O Get rights and content

Abstract

The perioperative management and the pathophysiology of a parturient with pulmonary atresia, ventricular septal defect, patent ductus arteriosus Botalli (PDA), and pulmonary hypertension are described. The patient previously had a cesarean section under general anesthesia and was currently managed with an epidural block. The outcome was successful for the mother. The postoperative period of the premature infant was characterized by hyaline membrane disease, with its typical sequelae.

References (11)

R.W. Collett et al.
Persistent truncus arteriosus classification according to anatomical types
Surg Clin North Am
(1949)
A. Mandel et al.
Cor tr iloculare biatriatum
Am Heart J
(1963)
N.C.T. Wilton et al.
Anaesthetic management for caesarean section in a patient with uncorrected truncus arteriosus
Br J Anaesth
(1989)
J.S. Crawford
Experiences with lumbar extradural analgesia for caesarean section
Br j Anaesth
(1980)
J.S. Crawford et al.
A pregnant patient with Eisenmenger's syndrome
Br J Anaesth
(1971)

There are more references available in the full text version of this article.

Cited by (12)

Anesthetic management for cesarean delivery in a patient with uncorrected pulmonary atresia, ventricular septal defect and major aortopulmonary collateral arteries
2018, International Journal of Obstetric Anesthesia
Citation Excerpt :
Considering that single-shot spinal anesthesia can generate hemodynamic instability, epidural anesthesia may be more beneficial for patients with cyanotic heart disease.12,13 Atanassoff et al.4 reported use of epidural anesthesia for cesarean delivery in a patient with uncorrected PA/VSD/PDA. The aim of the sensory block to touch is T5 in the anesthetic management of healthy women for cesarean delivery.
Pulmonary atresia with a ventricular septal defect and major aortopulmonary collateral arteries is an extremely rare congenital disorder characterized by a high risk of maternal mortality. We present the case of a 24-year-old primigravid woman with uncorrected pulmonary atresia, ventricular septal defect and major aortopulmonary collateral arteries who presented at 35+5 weeks’ gestation. Based on the pathophysiology of the congenital cardiac lesion, cesarean delivery was performed under epidural anesthesia under management by a multidisciplinary team. This report highlights the anesthesia management of a rare uncorrected congenital cardiac lesion for cesarean delivery.
Outcome of pulmonary vascular disease in pregnancy: A systematic overview from 1978 through 1996
1998, Journal of the American College of Cardiology
Objectives. Published reports were reviewed to evaluate the characteristics of peripartal management and the late pregnancy outcome in women with pulmonary vascular disease (PVD).
Background. Pulmonary hypertension poses one of the highest risks for maternal mortality, but actual data on the maternal and neonatal prognosis in this group are lacking.
Methods. Reports published from 1978 through 1996 of Eisenmenger’s syndrome (n = 73), primary pulmonary hypertension (PPH) (n = 27) and secondary vascular pulmonary hypertension (SVPH) (n = 25) complicating late pregnancy were included and analyzed using logistic regression analysis.
Results. Maternal mortality was 36% in Eisenmenger’s syndrome, 30% in PPH and 56% (p < 0.08 vs. other two groups) in SVPH. Except for three prepartal deaths due to Eisenmenger’s syndrome, all fatalities occurred within 35 days after delivery. Neonatal survival ranging from 87% to 89% was similar in the three groups. Previous pregnancies, timing of the diagnosis and hospital admission, operative delivery and diastolic pulmonary artery pressure were significant univariate (p < 0.05) maternal risk factors. Late diagnosis (p = 0.002, odds ratio 5.4) and late hospital admission (p = 0.01, odds ratio 1.1 per week of pregnancy) were independent predictive risk factors of maternal mortality.
Conclusions. In the last two decades maternal mortality was comparable in patients with Eisenmenger’s syndrome and PPH; however, it was relevantly higher in SVPH. Maternal prognosis depends on the early diagnosis of PVD, early hospital admission, individually tailored treatment during pregnancy and medical therapy and care focused on the postpartal period.
Outcome of Pregnancy in Patients with Complex Pulmonic Valve Atresia
1997, American Journal of Cardiology
General anesthesia for cesarean section in a parturient with a single ventricle and pulmonary atresia
1993, Journal of Clinical Anesthesia
The successful management of a cesarean section in a parturient with a single ventricle and pulmonary atresia using general anesthesia is discussed.
After cyanosis at birth, the patient underwent cardiac catheterization, which showed an apparent severe tetralogy of Fallot, atresia of the main pulmonary artery (PA), and a large patent ductus arteriosus. When she was 7 months of age, a Blalock-Taussig shunt (right subclavian artery to right PA) was done. She remained stable until age 11, when cyanosis increased and exercise tolerance decreased. Recatheterization more clearly defined the lesion: closed shunt, pulmonary valvular atresia, severe ductal stenosis, reduced pulmonary flow, double-outlet right
Cyanotic congenital heart disease and pregnancy: Natural selection, pulmonary hypertension, and anesthesia
1993, Journal of Clinical Anesthesia
Pregnancy carries substantial maternal and fetal risks in patients with uncorrected or palliatively corrected cyanotic congenital heart disease (CHD). In tricuspid valve Ebstein's anomaly, pregnancy is well tolerated. Maternal mortality in tetralogy of Fallot seems to be less than 10%, but it exceeds 50% in Eisenmenger's syndrome and primary pulmonary hypertension (PPH). Maternal hematocrit greater than 60%, arterial oxygen saturation lower than 80%, right ventricular hypertension, and syncopal episodes are poor prognostic signs. Maternal risk could be reduced by vaginal delivery.
Continuous monitoring of arterial and central venous pressure, electrocardiography, and pulse oximetry are recommended for every anesthetic procedure. The use of a pulmonary artery catheter is controversial and probably should be avoided in parturients with cyanotic CHD or PPH. The choice of anesthetic technique and drugs per se is of secondary importance and should be governed by individual preferences. Titration of anesthetic drugs, general anesthesia with controlled ventilation, or, preferably, regional anesthesia with spontaneous breathing should be used cautiously to avoid worsening of the preexisting condition.
Prevention of excessive erythrocytosis, volume and blood loss substitution, cardiocirculatory pharmacologic support, prophylaxis of infective endocarditis, and judicious use of anticoagulant drugs should be applied as indicated by the type and presentation of CHD. Poor outcome of pregnancy in PPH requires an early consideration of heart-lung or lung transplantation. Multidisciplinary team effort and prolonged monitoring in the intensive care unit are mandatory to ensure a favorable outcome for cyanotic CHD and PPH parturients.
Neuraxial anaesthesia in parturient with cardiac disease
2018, Indian Journal of Anaesthesia

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^∗: Assistant Professor of Anesthesiology

^†: Professor of Anesthesiology

^§: Assistant Professor of Pediatrics

^∥: Professor and Chairman of Anesthesiology

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Case reportEpidural anesthesia for a cesarean section in a patient with pulmonary atresia and ventricular septal defect

Abstract

Surg Clin North Am

Am Heart J

Br J Anaesth

Br j Anaesth

Br J Anaesth

Case report
Epidural anesthesia for a cesarean section in a patient with pulmonary atresia and ventricular septal defect