///2010 Abstract Details
2010 Abstract Details2019-08-03T15:49:10-05:00

MANAGEMENT OF A PREGNANT PATINE WITH CORRECTED TETRALOGY OF FALLOT

Abstract Number: 251
Abstract Type: Case Report/Case Series

OFER WELLISCH M.D.,MPH1 ; KALPANA TYAGARAJ M.D.2

Introduction:

The incidence of cardiac disease in pregnant patients in developed countries ranges between 0.2-3percent. Improvements in the diagnosis, treatment and surgical correction of congenital defects have allowed a significant number of women to reach childbearing age. Corrective surgery is done to widen part of the narrowed pulmonary tract and close the ventricular septal defect. Cardiovascular stress secondary to pregnancy, labor, delivery and the postdelivery period induces different degrees of cardiac failure. Concomitant cardiac medication and therapeutic anticoagulation can interfere with anesthetic management.

Case Report:

A 25 years, G1P0 female, at 40 weeks gestation, is scheduled for induction. Medical history is significant for Tetralogy of Fallot(Fig.1) repaired at age 5. Not on any medications.

Echocardiogram: normal LV and enlarged RV. Doppler color flow: mild tricuspid incompetence, a pulmonic gradient of 24 and mild pulmonary incompetence.

On examination: Height 63", Weight 180 lbs, Airway-MP-3, Heart -Harsh parasternal systolic murmur, Lungs- clear. NYHA Class 1. Vital signs 116/75 mm of Hg, HR 97/min, RR 12/min

Hct 38.6; Platelets 158,000

EKG: normal sinus rhythm and RBBB

Epidural analgesia was provided with Fentanyl 2 mcg/ml, Bupivicaine 0.1% at 10ml/hr. Obstetrician decided to perform C-Section for NRFHR. Two large bore intravenous catheters placed. Epidural Catheter bolused with 10 ml of 2% Lidocaine with epinephrine. After the delivery of the baby, uterine atony noted. Uterine massage and uterotonic agents failed to control the bleeding. Bilateral uterine artery ligation performed.

EBL: 3000 ml. Fluids: 4.3L crystalloid, 2 Units PRBCs and FFP.

Patient transferred to SICU for hemodynamic monitoring and further management.

Discussion:

*Pregnancy related cardiovascular changes, compression of IVC and aorta by the enlarged uterus as well as changes in vascular responsiveness- all have a negative impact on the pathology seen in the patients with Fallots tetralogy. Prognosis depends on the functional status.

*Hemodynamic goals of management: Avoid wide swings in blood pressure, maintain preload and normal to low heart rate, avoid myocardial depression, careful monitoring of fluid balance, readily available inotropic support and preload reduction after delivery

*An improvement in modern techniques of monitoring and multidisciplinary care has lead to a substantial improvement in outcomes of these patients.



SOAP 2010