Anesthetic management of a parturient with Ebstein anomaly palliated with Fontan procedure

Abstract

Women of childbearing age with surgically palliated congenital heart disease (CHD) have become increasingly common as survival rates of CHD improve. We describe a 33-year-old female with a history of Ebstein anomaly (EA), status post fenestrated lateral tunnel Fontan procedure, at gestational week 37 who presented for induction of labor and was found to have a fetal breech presentation. Cesarean section with general anesthesia was indicated after failure to progress in labor with epidural analgesia. As surgically treated EA has led to increased survivability, further discussion on the anesthetic management of this growing obstetric patient population was necessary.

Abbreviations: CO: cardiac output; CTPA: computed tomography pulmonary angiography; CHD: congenital heart disease; EA: Ebstein anomaly; LPA: left pulmonary artery; LT: lateral tunnel; PVR: pulmonary vascular resistance; RA: right atrium; SVC: superior vena cava; TTE: transthoracic echocardiogram; VR: venous return.

Keywords: Ebstein Anomaly; Congenital Heart Disease; Anesthesia; Fontan Procedure

Citation: Schmitt K, Tafalla J, Wells R, Rinehart J. Anesthetic management of a parturient with Ebstein anomaly palliated with Fontan procedure. Anaesth. pain intensive care 2025;29(2):341-344. DOI: 10.35975/apic.v29i2.2724

Received: July 18, 2023; Reviewed: December 03, 2023; Accepted: January 01, 2023