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

Anesthetic management for cesarean delivery in a patient with uncorrected pulmonary atresia, ventricular septal defect and major aortopulmonary collateral arteries

Pulmonary atresia witha 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 arterieswho 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.

Segmental epidural anesthesia for cesarean section in a parturient with uncorrected Taussig-Bing anomaly with transposition of the great arteries physiology

Here, we report a rare case of a 23-year-old term parturient with Eisenmenger syndrome due to Taussig-Bing anomaly presenting with gestational hypertension, oligohydramnios, and intrauterine growth retardation posted for elective cesarean section. Preoperatively, echocardiography of the patient was suggestive of double-outlet right ventricle (DORV) with large sub-pulmonic ventricular septal defect (VSD), right ventricular hypertrophy, bidirectional shunt and severe pulmonary artery hypertension. The surgery was successfully performed under a graded segmental epidural anesthesia with 2% lignocaine. Further contrast-enhanced computer tomography scan was done postoperatively and a diagnosis of Taussig-Bing anomaly (DORV with sub-pulmonic VSD) with transposition of the great arteries physiology was made. This is one of the rare cases of anesthetic management for cesarean section in a parturient with uncorrected Taussig-Bing anomaly being reported.

Management of labour and delivery in congenitally corrected transposition of great arteries

A descriptive case report of the labour and delivery management of a 28-year-old woman who presented with congenitally corrected transposition of great arteries, dextrocardia, systemic ventricular dysfunction and junctional tachycardia. Patients with congenitally corrected transposition have a thin-walled morphological right ventricle as the systemic circulatory pump. The stress of increased cardiac output can lead to congestive heart failure, systemic atrioventricular valve regurgitation and arrhythmias. We used minimally invasive continuous cardiac output monitoring, fluid balance optimization and good maternal pain control to prevent decompensation and achieve vaginal delivery with a good maternal and neonatal outcome.

The pregnant patient with congenital heart disease

Advances in the surgical palliation and correction of congenital heart lesions have improved survival and increased the number of patients living into adulthood. Although pregnancy outcomes will be favorable for most patients with congenital heart disease, the cardiovascular challenges associated with pregnancy and delivery are best managed with a multidisciplinary approach during the puerperium. This review addresses the prevalence, physiology, risk assessment, peripartum complications, and anesthetic management of the pregnant patient with underlying congenital heart disease.