Anesthetic Management of Parturients With Congenitaliy Corrected Transposition of the Great Arteries: Three Cases and a Review of the Literature

摘要

Parturients with congenitaliy corrected transposition of the great arteries (CCTGA) are uncommon. The condition carries with it a propensity for congestive heart failure and cardiac dysrhythmias during pregnancy, labor, and delivery. This report discusses the anesthetic management of 3 parturients with CCTGA and provides a review of relevant literature.A 34-year-old acyanotic woman presented at 39 weeks' gestation for elective cesarean delivery of a breech presentation.A CCTGA was diagnosed when she was 9 years old. An echocardiogram during her first trimester showed a CCTGA, a left atrioventricular (AV) valve replacement with no residual stenosis or regurgitation, and a systemic ventricular ejection fraction of 47%. She was hemodynamically stable before delivery. Standard noninvasive monitoring was initiated, and endocarditis prophylaxis was provided. A lumbar epidural catheter was placed, and after testing with lidocaine and epinephrine, additional lidocaine/epinephrine with 100 (xg of fentanyl was incrementally injected; a T3 sensory level was obtained. Surgical anesthesia was maintained with 3 mL of 3% 2-chloroprocaine given every 15 minutes. A low transverse cesarean delivery allowed delivery of a vigorous 3600-g infant. Oxytocin was administered. The patient was monitored in the intensive care unit (ICU) for 24 hours with no postpartum cardiovascular complications.