GENERAL-ANESTHESIA FOR CESAREAN-SECTION IN A PARTURIENT WITH A SINGLEVENTRICLE AND PULMONARY ATRESIA

The successful management of a cesarean section in a parturient with a single ventricle and pulmonary atresia using general anesthesia is di scussed. After cyanosis at birth, the patient underwent cardiac cathet erization, which showed an apparent severe tetralogy of Fallot, atresi a of the main pulmonary artery (PA), and a large patent ductus arterio sus. When she was 7 months of age, a Blalock-Taussig shunt (right subc lavian artery to right PA) was done. She remained stable until age 11, when cyanosis increased and exercise tolerance decreased. Recatheteri zation more clearly defined the lesion: closed shunt, pulmonary valvul ar atresia, severe ductal stenosis, reduced pulmonary flow, double-out let right ventricle, and severe hypoplasia of the left atrium, mitral valve, and left ventricle. A Potts shunt (left descending aorta to lef t PA) was done. Compliance with therapy was poor and follow-up difficu lt. Exercise tolerance was poor, but the patient remained otherwise st able. At 28 weeks' gestation, this 23 year-old parturient presented wi th severe congestive heart failure (CHF). After initial therapy with o xygen, bed rest, digoxin, and diuretics, she improved and remained sta ble for a month. At that time (32 weeks' gestation), CHF worsened. Bec ause the cervix was unfavorable for a vaginal delivery, a cesarean sec tion was planned. The patient was then taken to the operating room ele ctively, and an opioid-based general anesthetic was administered. Both mother and infant did well. This case is presented because the physio logy of the patient's lesion and her unusual social history presented challenges for her anesthetic management.