A 30-year-old woman with corrected
transposition of great arteries (c-TGA) was scheduled for elective
cesarean section at 37 weeks of gestation. At previous
cesarean section, she received
general anesthesia for
dyspnea and lower cardiac function by severe
mitral regurgitation, with a pulmonary
catheter inserted. In the current pregnancy, she had
tricuspid regurgitation, but she had no signs of
heart failure. Cardiac index (CI) and stroke volume variation (SVV) were monitored by the FloTrack, before induction of
anesthesia. Because the CI was 3.6 l x min(-1) x m(-2), and the SVV was 18%, we decided to perform combined spinal
epidural anesthesia.
Epidural anesthesia was performed at L1-2, and
spinal anesthesia was performed at L3-4. Hyperbaric 0.5%
bupivacaine 2.0 ml with
fentanyl 10 μg was given to the subarachnoid space. The total dose of
phenylephrine administered was 150 μg, and the CI as well as the SVV were stable during surgery. Her postpartum couse was uneventful.
Anesthetic management of c-TGA is discussed, and we should select
anesthetic method carefully.