Management of anesthesia in a pregnant patient with an unmodified congenital heart disease

Abstract

Congenital heart diseases (CHDs) affect approximately 0.8% of all the newborns with malformed structured heart or large vessels. Nowadays, due to the progress in medical methods and management, most women with CHD are expected to reach childbearing age. Noticeable improvement in anesthesia management is important for successful outcome and survival in pregnant patients with CHDs, even with the most complex disease. A multiparous patient, who had two components of cyanotic CHDs, which includes transposition of the great arteries (TGA) and single ventricle (atrioventricular connection) in childhood, got pregnant at the age of 39 years. She had a normal pregnancy course without any specific symptoms. She did not experience functional deterioration during her pregnancy. Termination of pregnancy was decided when intrauterine growth restriction (IUGR), was diagnosed by ultrasonography at 37 weeks, and a normal 1250‑g baby was delivered by cesarean section. This case report, records the anesthetic care of the 39‑year‑old female who underwent cesarean section due to IUGR. General anesthesia was successfully administered, with precise attention to maintenance of systemic vascular resistance (to minimize shunting), better oxygenation, administration of pre procedural antibiotics, and judicious replacement of intravenous fluids via air‑filtered tubing.