///2019 Abstract Details
2019 Abstract Details2019-07-13T07:45:15-05:00

Long QT syndrome during cesarean section under general anesthesia

Abstract Number: FCB-436
Abstract Type: Case Report Case Series

Kum Hee Chung M.D.1 ; KumHee Chung M.D.2

Long QT syndrome (LQTS) is a congenital disorder characterized by prolongation of QT interval in the electrocardiogram (ECG) and a propensity to develop ventricular arrhythmias, which may lead to syncope, cardiac arrest or sudden death. Congenital LQTS has been categorized by many genetic studies. The diagnostic rate has also improved by a diagnostic scoring system. A prolonged QT interval on the EKG is the essential condition of the LQTS but around 10~15% of LQTS patients shows normal QT interval. We present here a case of LQTS experienced during general anesthesia for cesarean section in a pregnant woman who had normal EKG findings before surgery and taking levothyroxine as hypothyroidism

Case report

A 38-year-old woman (body weight: 56 kg, height: 158 cm) at 34 weeks of pregnancy with history of dizziness and 2-3 episodes of syncope but no underlying disease diagnosed was admitted for emergency cesarean section due to oligohydroamnios, premature rupture of membranes and fetal distress. Chest X-ray, EKG, CBC, electrolytes, general chemistry, blood coagulation test, urinalysis at the time of admission were all within normal range. Initial vital sign were BP 100/50 mmHg and pulse rate (PR) 60 beat/min. Right after propofol 120 mg IV and succinylcholine 60mg IV were given, airway pressure increased, PR fastened to 135 beat/min and EKG showed large tall T wave and ST elevation. Patient was immediately intubated and given O2 2L/min, N2O 2L/min with sevoflurane at 1.0 vol.%. At the same time, the surgery started and immediately took out the baby and APGAR score was 7 at 1 min., 9 at 5 min. Amiodarone 150 mg mixed with 100 cc N/S was infused and isosorbide dinitrate (0.1 mg/ml) was infused. Patient’s EKG was normalized and BP was 70/40. Arterial cannulation was performed with a 20G catheter in the left radial artery, and central venous cannulation was done in the right internal jugular vein. After 1 to 2 minutes, torsade de pointes (TdP) ventricular tachycardia (VT) occurred and one defibrillation was performed. The EKG returned to normal sinus rhythm and blood pressure returned to 90/40. At this time, MgSO4 (2g + N / S 100 CC mixture) was infused. After the patient woke up after the surgery, she was transferred to intensive care unit after self-ventilation was confirmed. At the ICU, patient was alert with stable vital signs after 1 day and transferred to the general ward. There was no change in EKG afterward and no other neurologic abnormalities were found. Coronary angiography showed normal coronary arteries and ergonovine provocation test was negaive. After patient's recovery, family history of sudden death of patient's mother during vaginal delivery was found out. This required further evaluation, including genetic studies for the diagnosis of congenital long QT syndrome, but the patient refused. After the discharge, patient followed up with a cardiologist and showed healthy condition without any abnormal sequelae.

SOAP 2019