Anesthetic Management of Double Atrial Septal Defect with Moderate Pulmonary Hypertension Emergency Caesarean Section

Abstract

Atrial septal defect (ASD) is common congenital heart disease in adults. Most of the cases are detected in childhood, whereas few cases reach adulthood undiagnosed. It is the most common congenital heart lesion in child bearing age group girls. ASD leads to various complications depending upon size, position of ASD and shunt flow direction and hemodynamic change. Pulmonary artery hypertension is one such complication which occurs due to large blood flow across pulmonary artery due to left to right shunting. Pulmonary hypertension is defined as a mean pulmonary arterial pressure greater than 25 mm Hg at rest or greater than 30 mmHg during exercise. We reported a case of double ASD of size 10 mm and 5 mm with moderate pulmonary artery hypertension which underwent emergency caesarean section for meconium stained liquor. Under all aseptic precaution epidural catheter was placed at L3-4 level in sitting position by loss of resistance technique and then spinal anesthesia was given at the same level with 26G needle. Total drug given in spinal was 2.5 ml which includes 2 ml of bupivacaine (heavy) and 0.5 ml fentanyl. The patient was managed successfully under regional (epidural with low dose spinal) anesthesia without facing any complication. During anesthesia our main aim was to prevent complications, like hypotension, hypoxia, hypercarbia, reversal of shunt, fluid overload and maintain systemic pulmonary vascular resistance. As these complications adversely affect the outcome in heart disease patients.