Tet Spells in a Parturient Woman with Uncorrected Tetralogy of  Fallot Undergoing Cesarean Delivery

Saranya Lertkovit; Patchareya Nivatpumin

doi:10.31584/jhsmr.2021801

Tet Spells in a Parturient Woman with Uncorrected Tetralogy of Fallot Undergoing Cesarean Delivery

Saranya Lertkovit, Patchareya Nivatpumin

Abstract

Tetralogy of Fallot (TOF) is the most common, cyanotic congenital heart disease. The hemodynamic changes during pregnancy, with uncorrected TOF, result in serious, life-threatening complications for both patient and baby. The authors report on the successful anesthetic management of a 26-year-old parturient women. The patient was at a gestational age of 33 weeks, with uncorrected TOF. After undergoing a cesarean delivery, she developed intraoperative hypoxia after delivery. We postulated that the patient developed hypoxic Tet spells from hypovolemia, resulting from postpartum bleeding as well as a decrease in her systemic vascular resistance from oxytocin. A multidisciplinary team approach and invasive intraoperative monitoring together with meticulous anesthetic management, were essential for this patient.

Keywords

anesthesia; cesarean delivery; hypoxic spell; Tet spells; Tetralogy of Fallot

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References

Baum VC, De Souza DG. Congenital heart disease in adults. In: Kaplan JA, Augoustides JGT, editors. Kaplan’s cardiac anesthesia for cardiac and noncardiac surgery. 7th ed. Philadelphia PA: Elsevier; 2017;p.818-42.

Nasr VG, Dinardo JA. Tetralogy of Fallot (TOF). In: Nasr VG, Dinardo JA, editors. The pediatric cardiac anesthesia handbook. Hoboken: John Wiley & Sons; 2017;p.131-46.

Bellapukonda S, Roncall BR, Mund M. Management of a parturient with uncorrected tetralogy of Fallot in shock: an anesthetic challenge. BMJ Case REP 2019;12:e231517.

Kaur H, Suri V, Aggarwal N, Chopra S, Vijayvergiya R, Talwar KK. Pregnancy in patients with tetralogy of fallot: outcome and management. World J Pediatr Congenit Heart Surg 2010; 1:170-4

Wang K, Xin J, Wang X, Yu H, Liu X. Pregnancy outcomes among 31 patients with tetralogy of Fallot, a retrospective study. BMC Pregnancy Childbirth [serial on the Internet]. 2019 Dec [cited 2020 May 21]; 19:486. Available from: http:// bmcpregnancychildbirth.biomedcentral.com/articles/10.1186/ s12884-019-2630-y

Tawifik MM, Tarbay AI, Abdelkhalek A. Cesarean section in parturients with uncorrected tetralogy of Fallot. Int J Obstet Anesth 2015;24:191-8.

Alkaya Solmaz F, Cuhruk H. The application of epidural anesthesıa in pregnant woman with uncorrected tetralogy of Fallot: a case report. Agri 2015;27:215-8.

Parker JA, Grange C. Anaesthetic management of a parturient with uncorrected tetralogy of Fallot undergoing caesarean section. Int J Obstet Anesth 2015;24:191-2.

Shukry M, Miller JA. Update on dexmedetomidine: use in nonintubated patients requiring sedation for surgical procedures. Ther Clin Risk Manag 2010;6:111-21.

Gertler R, Brown HC, Mitchell DH, Silvius EN. Dexmedetomidine: a novel sedative-analgesic agent. Proc (Bayl Univ Med Cent) 2001;14:13-21.

Bautista L. Dexmedetomidine for every cesarean delivery…maybe not?. Can J Anesth 2019;66:751-4.

Yoshimura M, Kunisawa T, Suno M, Sugawara A, Kurosawa A. Intravenous dexmedetomidine for cesarean delivery and its concentration in colostrum. Int J Obstet Anesth 2009;18:403-7.

Ibrahim EEA, Amer MM, Ab, Abuelnaga ME, Abd-Elaal W. Dexmedetomidine infusion during caesarean section under general anaesthesia: evaluation of maternal awareness using BIS, maternal and neonatal outcomes. Egypt J Anaesth 2018; 34:145-50.

Wilkinson KL, Brunskill SJ, Doree C, Trivella M, Gill R, Murphy MF. Red cell transfusion management for patients undergoing cardiac surgery for congenital heart disease. Cochrane Database Syst Rev 2014,7;CD009752.

Committee on Practice Bulletins-Obstetrics. Practice Bulletin No.183: Postpartum Hemorrhage. Obstet Gynecol 2017;130: e168-86.

Nivatpumin P. Uterotonic Agents Used in Cesarean Delivery. Thai J Anesthesiol 2019;45:124-31.

Clivatti J, Smith RL, Sermer M, Silversides C, Carvalho JC. Cardiac output monitoring during cesarean delivery in a patient with palliated tetralogy of Fallot. Can J Anaesth 2012;59: 1119-24.

Arendt KW, Lindley KJ. Obstetric anesthesia management of the patient with cardiac disease. Int J Obstet Anesth 2019;37: 73-85.

DOI: http://dx.doi.org/10.31584/jhsmr.2021801

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