Case report: Anethesia for cessarean seccion in tricuspid atresia

Carrillo Aybar Y.N.; Gonzales R.M. · Revista Chilena de Anestesia (2021) · DOI: 10.25237/revchilanestv50-03-06

Resumen

Introduction: In developed countries congenital heart disease is one of the most frequent cardiac diseases in pregnancy, while valvular disease has a higher prevalence in developing countries. In order to perform multidisciplinary management and avoid fatal outcomes it is important to know and review the relevant literature when we take care of a pregnant patient with congenital heart disease. Case description: We describe a case of a 35 year old multiparous pregnant woman, with a diagnosis of tricuspid atresia with perimembranous interventricular septal defect, presented at 31 weeks gestation for an emergency cesarean section for the third time. A low dose sequential combined spinal epidural block technique was performed. First-line uterotonics were used associated with a restricted water balance. During pregnancy, the patient presented central and peripheral cyanosis, nail clubbing, and oxygen saturation of 78% on room air. In addition, a review of the literature was made. Discussion: It is important to perform risk stratification in pregnant women with congenital or acquired heart disease, and a multidisciplinary management should be carried out preserving the mother-child binomial wellbeing. Neuroaxial anesthesia can be indicated in some cases, with the appropriate use of uterotonics and restricted water balance can improve the outcomes in the management of pregnant women with heart disease. Conclusion: Neuraxial techniques must be individualized. Knowing the pathophysiology of congenital heart disease and cardiovascular physiological changes during pregnancy is important for proper management of this type of patient. A low dose sequential combined spinal epidural block technique was effective and safe in this patient.