Anaesthetic management of emergency exploratory laparotomy for ruptured ectopic pregnancy in a patient with Ebstein’s anomaly and Wolff-Parkinson-White syndrome: a challenge for the anaesthesiologists

Pooja Singh, Sudhakar Dwivedi, Rajeev Dwivedi, Avtar Yadav


Ebstein's anomaly (incidence 1:110,000) is characterized by the downward displacement and elongation of the tricuspid valve with poorly contractile right ventricle, an enlarged right atrium along with tricuspid regurgitation. It has shown particular association with Wolf-Parkinson-White syndrome (up to 20 % of patients). Wolff-Parkinson-White syndrome (WPW syndrome) is a rare cardiac anomaly characterised by aberrant conduction pathway between atria and ventricles. Here we describe the successful management of a patient with Ebstein’s anomaly and co-existing WPW syndrome, who presented in our institute with ruptured ectopic pregnancy and was posted for emergency exploratory laparotomy. The anaesthetic management of these patients is very challenging as they can develop life threatening tachyarrthmias like atrial fibrillation (AF) and paraoxysmal supraventricular tachycardia (PSVT).


Ebstein’s anomaly with WPW syndrome, Ruptured ectopic pregnancy, Anaesthetic management

Full Text:



Mann RJ, Lie JT. The life story of wilhelm ebstein and his almost overlooked description of a congenital heart disease. Mayo Clin Proc. 1979;54:197-203.

Misa VS, Pan PH. Evidence-based case report for analgesic and anesthetic management of a parturient with ebstein's anomaly and wolff-parkinson-white syndrome. Int J Obstet Anesth. 2007;16:77-81.

Groves ER, Groves JB. Epidural analgesia for labour in a patient with Ebstein's anomaly. Can J Anaesth. 1995;42:77-9.

Sethi KK, Dhall A, Chadha DS, Garg S, Malani SK, Mathew OP, et al. WPW and preexcitation syndromes. J Assoc physicians India. 2007;55(supplement):10-5.

Seki S, Ichimiya T, Tsuchida H, Namiki A. A case of normalization of Wolff-Parkinson-White syndrome conduction during propofol anaesthesia. Anesthesiology. 1999;90:1779-81.

Sharpe MD, Dobkowski WB, Murkin JM, Klein G, Guiraudon G, Yee R. The electrophysiologic effects of volatile anaesthetics and sufentanil on the normal atrioventricular conduction system and accessory pathways in Wolff-Parkinson-White Syndrome. Anaesthesiology. 1994;80:63-70.

Savarese JJ, Caldwel JE, Lien CA, Miller RD. Pharmacology of muscle relaxants and their antagonists. In: Miller RD, eds. Anaesthesia. 5th ed. Philadelphia London Toronto Montreal Sydney Tokyo Edinburgh: Churchill Livingstone. 2000:412-90.