Anesthetic management of a case of a large atrial septal defect with mild pulmonary hypertension for emergency cesarean section

Abstract

Atrial septal defect (ASD) is the most common congenital acyanotic heart disease in adults and accounts for 10%
of congenital cardiac defects in adults. . It is the most commonly seen congenital cardiac lesion in women of childbearing
age and the pregnancy is usually well tolerated. Pulmonary hypertension is defined as a mean pulmonary
arterial pressure greater than 25mm Hg at rest or greater than 30mm Hg during exercise. We report a case of a
large ASD with mild pulmonary hypertension in a patient who underwent emergency caesarean section under
general anaesthesia for failure to progress. During the general anaesthesia for the procedure our objectives were
to to avoid hypotension, hypoxaemia, hypercarbia, hypothermia, reversal of shunt (Eisenmenger’s syndrome)
and fluid overload. The patient had an eventful perioperative course and discharged from the hospital on the 8th
postoperative day in good physical condition.