Anesthetic management of a pregnant patient with congenitally corrected transposition of the great arteries for labor and vaginal delivery

A patient with congenitally corrected transposition of the great arteries ( CCTGA), which is a rare form of congenital heart disease that is characteri zed by discordant atrioventricular and ventriculoarterial connections, was admitted for induction of labor at 40 weeks' gestation. This patient was fi rst diagnosed with CCTGA at 20 weeks' gestation and had experienced recurre nt supraventricular tachycardia (SVT) during her pregnancy. An early epidur al infusion of local anesthetic and opioid was administered to decrease mat ernal catecholamine release and prevent tachycardia associated with labor p ain. Noninvasive blood pressure, continuous lectrocardiography, and pulse o ximetry were monitored, and supplemental oxygen was provided. Various cardi ac medications were made immediately available to promptly treat a SVT if n ecessary. The patient remained hemodynamically stable throughout labor and vaginal delivery. The anatomical defects of CCTGA, associated conditions, p hysiologic concerns, and treatment options are reviewed. (C) 2001 by Elsevi er Science Inc.