Management of a parturient with uncorrected tetralogy of Fallot in shock: an anesthetic challenge

Abstract

Tetralogy of Fallot (TOF) is the most common form of cyanotic congenital heart disease. The survival of patients with uncorrected TOF till the fourth decade of life is rare (around 3%). Pregnancy in a patient with uncorrected TOF requires a multidisciplinary approach. A confluence of pregnancy, uncorrected TOF and shock is infrequent. The state of hypovolaemia and a decrease in systemic vascular resistance due to anaesthetic agents increase the right to left shunt. The decrease in pulmonary blood flow provokes a ‘hypercyanotic spell’. We report the successful management of 30-year-old pregnant (G3P2A2L0) with uncorrected TOF, presenting to the emergency department with incomplete abortion in shock.

A unique case of uncorrected Fallot's tetralogy with nasal dermoid cyst and median cleft lip presenting during postpartum

“…[ 14 ] Evidence of successful pregnancy outcome in uncorrected TOF without any antenatal checkup is limited in literature. [ 3 14 ] There are reports describing favorable feto-maternal outcome among uncorrected TOF patients with intensive obstetric, anesthetic, and cardiac care. [ 3 15 16 ] Our patient was unique as she received no medical attention till she presented with PPH, heralding cardiogenic shock.…”

“…[ 3 14 ] There are reports describing favorable feto-maternal outcome among uncorrected TOF patients with intensive obstetric, anesthetic, and cardiac care. [ 3 15 16 ] Our patient was unique as she received no medical attention till she presented with PPH, heralding cardiogenic shock. This also highlights dismal healthcare access and awareness among poor tribal people of the region.…”

“…While patients with tetralogy of Fallot (TOF) can nowadays survive up to adulthood due to the advent of corrective surgeries,[ 1 ] its first presentation during postpartum period and a successful pregnancy outcome is extremely rare. [ 2 3 ] Although TOF along with other congenital heart diseases (CHD) are frequently associated with multiple other congenital anomalies including midfacial defects,[ 4 ] nasal dermoid cyst (NDC) in junction with CHD in an adult has never been described before. In this report, authors describe a unique combination of TOF in association with NDC and median cleft lip in a woman presented for the first time with postpartum hemorrhage (PPH) after an unsupervised home birth.…”

The Successful Management of an Adult Patient With Unrepaired Tetralogy of Fallot for Caesarian Section: A Case Report From South Africa

“…Tetralogy of Fallot (TOF) is the commonest known cyanotic congenital heart defect [1]. First diagnosed by French physician Arthur Fallot in 1888, it is a condition thought to be caused by incomplete rotation and abnormal division of the conotruncus of the embryonic heart [2]. Usually diagnosed in early life, it is characterized by four interlinked cardiac defects, namely pulmonary stenosis (PS), ventricular septal defect (VSD), overriding aorta, and right ventricular hypertrophy (RVH) [3].…”

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

“…2 Pregnancy with uncorrected TOF involves a maternal mortality rate of 3.0-12.0%, as well as a high rate of perinatal loss. [3][4][5] Contained within is the authors report on the successful anesthetic management of intraoperative Tet spells in a woman with uncorrected TOF, who underwent cesarean delivery under general anesthesia.…”