General Anesthesia for Cesarean Section in a Pregnant Woman with Truncus Arteriosus Intraoperatively Monitored by Transesophageal Echocardiography

Authors

  • Sumidtra Prathep Department of Anesthesiology, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla 90110, Thailand.
  • Suttasinee Petsakul Department of Anesthesiology, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla 90110, Thailand.
  • Natticha Chainarong Department of Obstetrics and Gynecology, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla 90110, Thailand.
  • Sirichai Cheewatanakornkul Department of Internal Medicine, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla 90110, Thailand.
  • Jutarat Tanasansuttiporn Department of Anesthesiology, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla 90110, Thailand.

DOI:

https://doi.org/10.31584/jhsmr.2021799

Keywords:

cesarean section, general anesthesia, pregnancy, transesophageal echocardiogram, truncus Arteriosus

Abstract

Truncus arteriosus (TA) is defined as a congenital cardiovascular malformation in which one great artery arises from the base of the heart and gives origin to the pulmonary and systemic arteries. TA patients who become pregnant have high morbidity and mortality rates because physiologic changes during pregnancy can worsen the cardiopulmonary balance causing cardiopulmonary decompensation. In this case report we report a successful general anesthesia in a truncus arteriosus patient with severe pulmonary hypertension (Eisenmenger syndrome) who underwent a full-term pregnancy delivery monitored by intraoperative transesophageal echocardiography, a new technique to assist physicians in dealing with patients with hemodynamic instability during both cardiac and noncardiac surgery.

References

Calder L, Van Praagh R, Van Praagh S, Sears WP, Corwin R, Levy A et al. Truncus arteriosus communis. Clinical, angiocardiographic, and pathologic findings in 100 patients. Am Heart J 1976;92:23–38.

Rosen RD, Bordoni B. Embryology, aortic arch [monograph on the Internet]. Treasure Island (FL): StatPearls Publishing; 2020 [cited 2020 May 9]. Available from: http://www.ncbi.nlm.nih.gov/ books/NBK553173/

Collett RW, Edwards JE. Persistent truncus arteriosus: a classification according to anatomic types. Surg Clin North Am 1949;29:1245–70.

Naimo PS, Fricke TA, Yong MS, d’Udekem Y, Kelly A, Radford DJ, et al. Outcomes of truncus arteriosus repair in children: 35 years of experience from a single institution. Semin Thorac Cardiovasc Surg 2016;28:500–11.

Drenthen W, Boersma E, Balci A, Moons P, Roos-Hesselink JW, Mulder BJM et al. Predictors of pregnancy complications in women with congenital heart disease. Eur Heart J 2010;31: 2124–32.

Arendt KW, Lindley KJ. Obstetric anesthesia management of the patient with cardiac disease. Int J Obstet Anesth 2019;37: 73–85.

Bosatra MG, Passarani S, Marino MR, Marcolin R, Fumagalli R, Pesenti A. Caesarean delivery of a patient with truncus arteriosus. Int J of Obstet Anesth 1997;6:279–84.

Wilton NC, Traber KB, Deschner LS. Anaesthetic management for caesarean section in a patient with uncorrected truncus arteriosus. Br J Anaesth 1989;62:434–8.

Abid D, Kahla SB, Mallek S, Abid L, Kammoun S, Daoud E, et al. Unrepaired persistent truncus arteriosus in a 38-year-old woman with an uneventful pregnancy. Cardiovasc J Afr 2015; 26:e6–8.

Lopez BM, Davies LK, Rabai F, Gonzalez Velez JM, Malham I, Marelli A. Eisenmenger syndrome in pregnancy: a management Conundrum. J Cardiothorac Vasc Anesth 2020;34. doi:10.1053/ j.jvca.2020.02.053.

Soma-Pillay P, Catherine NP, Tolppanen H, Mebazaa A, Tolppanen H, Mebazaa A. Physiological changes in pregnancy. Cardiovasc J Afr 2016;27:89–94.

Hoefnagel A, Yu A, Kaminski A. Anesthetic Complications in Pregnancy. Crit Care Clin 2016;32:1–28.

Devroe S, Van de Velde M, Rex S. General anesthesia for caesarean section. Curr Opin Anaesthesiol 2015;28:240–6.

Kodali BS, Chandrasekhar S, Bulich LN, Topulos GP, Datta S. Airway changes during labor and delivery. Anesthesiology 2008;108:357–62.

Frerk C, Mitchell VS, McNarry AF, Mendonca C, Bhagrath R, Patel A, et al. Difficult Airway Society 2015 guidelines for management of unanticipated difficult intubation in adults. Br J Anaesth 2015;115:827–48.

Afolabi BB, Lesi FEA. Regional versus general anaesthesia for caesarean section. Cochrane Database Syst Rev 2012;10: CD004350.

Staudt GE, Shelton K. Development of a rescue echocardiography protocol for noncardiac surgery patients. Anesth Analg 2019;129:e37–40.

Ruffolo RR. The pharmacology of dobutamine. Am J Med Sci 1987;294:244–8.

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Published

2022-03-15

How to Cite

1.
Prathep S, Petsakul S, Chainarong N, Cheewatanakornkul S, Tanasansuttiporn J. General Anesthesia for Cesarean Section in a Pregnant Woman with Truncus Arteriosus Intraoperatively Monitored by Transesophageal Echocardiography. J Health Sci Med Res [Internet]. 2022 Mar. 15 [cited 2024 Dec. 23];39(6):503-8. Available from: https://he01.tci-thaijo.org/index.php/jhsmr/article/view/255311

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Section

Case Report