Anesthesia Management in Patient with Uncorrected Double Outlet Right Ventricle Underwent Cesarean Section: Serial Case Report

Ruddi Hartono,Ilham Fadlilah,Isngadi Isngadi

doi:10.21776/ub.jap.2022.003.01.06

Ruddi Hartono, Ilham Fadlilah + Show 1 more

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https://doi.org/10.21776/ub.jap.2022.003.01.06

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Abstract

Background: Double outlet right ventricle (DORV) is a rare cardiac condition in which the heart demonstrates single ventricle physiology. Pregnancy complicates cyanotic heart disease as the decrease in systemic vascular resistance (SVR) worsens the right-to-left shunt. The effect worsens by neuraxial anesthesia for cesarean delivery. Anesthesia for these patients needs understanding for the physiology of DORV in order to maintain stable hemodynamics. Heart defect still become non obstetric main factor causing morbidity and mortality in pregnant woman. Case: We present three case of parturients with DORV scheduled for cesarean section. Elective caesarean section was scheduled using spinal anesthesia hyperbaric bupivacain combined with fentanyl. Hemodynamic during operation was stable. Conclusion: Low dose spinal anesthesia performed in this patient did not cause hypotension and minimal hemodynamic changes because the intensity of the sympathetic block was lower.

Highlights

Cardiac abnormalities in pregnancy are still the main non-obstetric factors causing morbidity and mortality in pregnant women.[1]
Four different anatomic types of Double outlet right ventricle (DORV) are defined on the basis of the relationship of the ventricular septal defect (VSD) to the great arteries: subaortic VSD, sub-pulmonary VSD, doubly committed VSD, and noncommitted VSD
Several studies concluded that low doses of spinal anesthesia do not cause hemodynamic changes and fentanyl as an adjuvant has the effect of prolonging adequate analgesia and motor block so that in this patient we performed anesthesia with low doses of spinal anesthesia and found no hypotension or other hemodynamic changes.[1,2,6,7,8]. In this serial case report, we evaluate the outcome of the low dose spinal anesthesia technique in pregnant patients with cardiac abnormalities undergoing sectio caesarea

Summary

Background

Double outlet right ventricle (DORV) is a rare cardiac condition in which the heart demonstrates single ventricle physiology. Pregnancy complicates cyanotic heart disease as the decrease in systemic vascular resistance (SVR) worsens the right-to-left shunt. The effect worsens by neuraxial anesthesia for cesarean delivery. Anesthesia for these patients needs understanding for the physiology of DORV in order to maintain stable hemodynamics. Case: We present three case of parturients with DORV scheduled for cesarean section. Elective caesarean section was scheduled using spinal anesthesia hyperbaric bupivacain combined with fentanyl. Conclusion: Low dose spinal anesthesia performed in this patient did not cause hypotension and minimal hemodynamic changes because the intensity of the sympathetic block was lower. Anesthesia Management in Patient with Uncorrected Double Outlet Right Ventricle Underwent Cesarean Section: Serial Case Report.

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CONCLUSION