MULTIDISCIPLINARY ANESTHETIC CARE IN EMERGENCY CESAREAN SECTION FOR CARDIAC ANOMALIES: A CASE OF ASD AND PAPVD

Abstract

Cardiac diseases in pregnancy, such as atrial septal defect (ASD) and partial anomalous pulmonary venous drainage(PAPVD),present unique challenges due to the physiological changes of pregnancy,which increase cardiovascular demands. This case report describes the anesthetic management of a 24-year-old pregnant woman at 37 weeks and 4 days of gestation with a history of ASD and PAPVD undergoing an emergency lower segment cesarean section (LSCS). The patient’s preoperative evaluation revealed stable vitals but
identified multiple ectopic beats on electrocardiography (ECG), necessitating close perioperative monitoring. A combined spinal-epidural anesthetic technique was employed, using low-dose hyperbaric bupivacaine and fentanyl for spinal anesthesia, and ropivacaine with lignocaine for the epidural component. This approach provided effective pain control while maintaining hemodynamic stability. The intraoperative course was uneventful, with estimated blood loss of 300 mL and adequate urine output, reflecting optimal fluid balance management. Postoperative recovery was smooth, with no complications, and the neonate was delivered healthy. This case highlights the importance of a multidisciplinary approach, individualized anesthetic planning, and vigilant perioperative monitoring in managing high-risk pregnancies complicated by congenital heart disease. The successful outcome emphasizes the need for integrating obstetric, anesthetic, and cardiology expertise to optimize maternal and neonatal outcomes in complex obstetric cases.