Cardiac output monitoring during Cesarean delivery in a patient with palliated tetralogy of Fallot

Abstract

Purpose Tetralogy of Fallot (TOF) is one of the most common causes of cyanotic congenital heart disease. The anesthetic management of parturients with uncorrected TOF is challenging and controversial, especially for Cesarean delivery (CD). We describe the use of noninvasive cardiac output (CO) monitoring to assist the management of CD for a woman with palliated TOF under general anesthesia. Clinical features A 34-yr-old woman presented for elective CD at 38 weeks gestation. Having been born with TOF, she underwent a modified Blalock-Taussig shunt at six years of age, followed nine years later by creation of an aortopulmonary connection. The patient's functional status was New York Heart Association class I despite evident central cyanosis. A CD was performed under general anesthesia. Fentanyl, etomidate, and succinylcholine were utilized for induction, and intrathecal morphine was administered for postoperative pain control. The baseline CO (7.2 LÁmin -1 ), blood pressure (156/74 mmHg), heart rate (74 beatsÁmin -1 ), and total peripheral resistance (1,059 dynesÁsec -1 Ácm -5 ) remained stable throughout the procedure. Maintenance anesthesia consisted of rocuronium, sevoflurane, and an oxygen/nitrous oxide mixture. Upon delivery, an infusion of oxytocin combined with ergometrine was administered. Hemodynamic parameters remained stable and no vasopressor was required. Conclusion Balanced general anesthesia and careful titration of uterotonic agents provided stable hemodynamic conditions during CD in a patient with a palliated TOF, as assessed by a continuous noninvasive CO monitor. Noninvasive CO monitoring may improve our understanding of the hemodynamic implications of various anesthetic techniques for CD in cardiac patients. RésuméObjectif La te´tralogie de Fallot (TF) est l'une des causes les plus fre´quentes de cardiopathie conge´nitale cyanosante. La prise en charge anesthe´sique des parturientes ayant une TF non corrige´e est controverse´e et rele`ve du de´fi, en particulier en cas d'accouchement par ce´sarienne. Nous de´crivons l'utilisation d'un monitorage non invasif du de´bit cardiaque (DC) pour aider la prise en charge de la ce´sarienne chez une femme ayant une TF ope´re´e sous anesthe´sie ge´ne´rale. Caractéristiques cliniques Une femme aˆge´e de 34 ans se pre´sente pour une ce´sarienne programme´e à 38 semaines de grossesse. Elle est ne´e avec une TF et a subi une intervention modifie´e de Blalock-Taussig a`l'aˆge de six ans, puis neuf ans plus tard la cre´ation d'une connexion aorto-pulmonaire. Le statut fonctionnel de la patiente

Tet Spells in a Parturient Woman with Uncorrected Tetaratolgy of Fallots Undergoing Cesarean Delivery

“…The second-and third-line uterotonic agents, including ergot alkaloid and prostaglandin, were not used because of their cardiovascular and pulmonary hypertensive effects. [16][17][18] TOF is a severe type of congenital heart disease that poses substantial risks to both mother and fetus. Anesthetic management requires a good understanding of anatomical defects and physiological adaptations.…”

Anesthetic Management for Laparoscopic Tubal Ligation in Adult Patient with Repaired Tetralogy of Fallot: Case Report

“…allot tetralojisi [Tetralogy of Fallot (TOF)], en yaygın siyanotik konjenital kalp hastalığı (KKH) nedenlerinden biridir ve KKH içerisinde insidansı %9-14'tür. 1,2 Cerrahi onarım yapılan hastaların çoğu, makul bir yaşam kalitesi ile erişkin yaşa kadar yaşayabilirler, ancak cerrahi onarım yapılmaksızın 30-40 yaş arasındaki erişkinlerde beklenen sağkalım oranı %3-6'dır. 3 Bu hastalar, yaşamlarının herhangi bir döneminde kardiyak veya nonkardiyak cerrahi için anestezi uygulamalarına ihtiyaç duyabilirler.…”

“…3 Bu hastalar, yaşamlarının herhangi bir döneminde kardiyak veya nonkardiyak cerrahi için anestezi uygulamalarına ihtiyaç duyabilirler. 2 Jinekolojik cerrahilerde postoperatif daha az ağrı ve analjezik gereksinimi, daha az morbidite ve mortalite ve daha az hastanede kalış süresi gibi avantajları nedeni ile laparoskopik prosedürler genellikle laparatomiye ter- A An na ah h t ta ar r K Ke e l li i m me e l le er r: : Laparoskopi; fallot tetralojisi; kısırlaştırma, tübal; anestezi A AB BS S T TR RA AC CT T Tetralogy of Fallot is a complex and common cyanotic heart defect. The population of patients surviving to late adulthood with tetralogy of Fallot is progressively growing.…”

“…Literatürde, başarılı nonkardiyak cerrahi (örneğin; sezaryenle doğum) geçiren düzeltilmiş TOF'lu erişkin hasta çalışmaları vardır ve bu hastalarda anestezi yönetimi genellikle sağlıklı bireylerdekine benzer şekilde gerçekleştirilmiştir. 2 Ancak, TOF'lu hastalarda, laparoskopik cerrahi için anestezi ile ilgili deneyim kısıtlıdır. 7 Laparoskopik cerrahi, günümüzde tüm dünyada yaygın şekilde uygulanmaktadır.…”

Cesarean section in parturients with uncorrected tetralogy of Fallot

“…3 Factors increasing pulmonary vascular resistance (hypoxia, hypercarbia and acidosis) can be managed with controlled mechanical ventilation provided high intrathoracic pressures are avoided. 4 We relied on PaCO 2 rather than end-tidal CO 2 to regulate minute ventilation as the latter may largely underestimate the true PaCO 2 level in uncorrected TOF patients. 5 Phenylephrine was planned to treat hypotension, with propranolol available if hypoxemia worsened.…”