Published: 2019-06-28

Anaesthetic management of a pregnant woman with uncorrected tetralogy of fallot for caesarean section

Anjana Badhan, Ankita Chandel, Shreya Das Adhikari


Tetralogy of fallot (TOF) is the most commonly encountered congenital cyanotic heart disease in pregnant females and maternal mortality approaches 10% in unrepaired TOF. General anesthesia is classically considered the technique of choice for incidental surgery in TOF and neuraxial anesthesia is considered relatively contraindicated. However, general anesthesia for caesarean section can increase maternal morbidity. Author report a case of caesarean section performed under epidural anesthesia in patient with uncorrected TOF.


Anaesthesia, Congenital

Full Text:



Cunningham FG, Gant NF, Leveno KJ, Gilstrap LC III, Hauth JC, Wenstrom KD. Williams Obstetrics. 21st ed. New York: McGraw-Hill; 2001: 1193.

Gomar C, Errando CL. Neuraxial anesthesiain obstetrical patients with cardiac disease. Curr Opin Anaesthesiol. 2005;18(5):507-12.

Kuczkowski KM, Reisner LS, Lin D. Anesthesia for cesarean section. In: Chestnut D.H, eds. Obstetric Anesthesia Principles and Practice. 3rd ed. Philadelphia: Elsevier Mosby; 2004: 429-439.

Drenthen W, Pieper GP, Roose-Hesselink JW, Lottum WA, Voors AA, et al. Outcome of pregnancy in women with congenital heart disease: a literature review. J Am Coll Cardiol. 2007;49(24):2303-11.

Roberts SL, Chestnut DH. Anesthesia for the obstetric patient with cardiac disease. Clin Obstet Gynecol 1987;30(3):601-10.

Veldtman GR, Connolly HM, Grogan M, Ammash NM, Warnes CA. Outcomes of Pregnancy in Women with Tetralogy of Fallot. J Am Coll Cardiol 2004;44(1):174-80.

Dyer RA, Joubert IA. Low-dose spinal anaesthesia for caesarean section, Curr Opin Anaesthesiol. 2004;17:301-8.

Oshita S, Uchimoto R, Oka H, Saka Y, Takeshita H, Funatsu N. Correlation between arterial blood pressure and oxygenation in tetralogy of Fallot. J Cardiothorac Anesth 1989; 3: 597–600.

Roofthooft E, Velde M. Low dose spinal anesthesia for cesarean section to prevent spinal induced hypotension. Curr Opin Anaesthesiol. 2008;21(3):259-62.

Tanaka K, Kitahata H, Kawahito S, Nozaki J, Tomiyama Y, Oshita S. Phenylephrine increases pulmonary blood flow in children with tetralogy of Fallot. Can J Anaesth. 2003;50(9):926-9.

Thomas JS, Koh SH, Cooper GM. Haemodynamic effects of oxytocin given as I.V. bolus or infusion on women undergoing Cesarean section. Br J Anaesth 2007;98(1):116-9.