Department of Anesthesiology, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA.
Anesth Analg. 2011 Aug;113(2):307-17. doi: 10.1213/ANE.0b013e31821ad83e. Epub 2011 May 19.
Most case reports of pregnancies after surgical repair of tetralogy of Fallot have focused on cardiovascular and obstetric concerns, with relatively few authors focusing on specific intrapartum and postpartum anesthetic management strategies.
The Mayo Clinic Congenital Heart Disease Clinic and the Boston Adult Congenital Heart Disease Service databases were cross-referenced with the Mayo Clinic and the Brigham and Women's Hospital Department of Anesthesiology databases to identify patients with tetralogy of Fallot who delivered at their respective hospital from January 1, 1994, to January 1, 2008. We reviewed each medical record to evaluate parturient care during pregnancy, labor, and delivery with a focus on anesthetic management.
During the 14-year study period, a total of 27 deliveries in 20 patients with repaired tetralogy of Fallot were identified. Twenty-one deliveries (78%) among 15 parturients (75%) involved a trial of labor; all parturients received neuraxial analgesia for labor and delivery, including 18 (86%) epidural, 2 (10%) combined spinal-epidural, and 1 (5%) continuous spinal anesthetic after an unintended dural puncture. Of the 21 patients undergoing labor, 3 (14%) received invasive arterial blood pressure monitoring; 5 (24%) received continuous telemetry; 3 (14%) experienced congestive heart failure that required diuresis; 4 (19%) had obstetric or neonatal complications; and 3 (14%) had anesthesia complications. Cesarean delivery was required in 4 patients (19%) because of labor complications. Concurrent cardiovascular, obstetric, and anesthetic complications in 1 patient resulted in neonatal death. Six (22%) parturients underwent elective cesarean delivery; 4 received epidural and 2 received spinal anesthesia; no anesthetic or immediate obstetric complications occurred. Among all parturients, 5 deliveries in 5 separate parturients (19% of deliveries) reported symptoms of congestive heart failure at the time of delivery.
Pregnancy outcomes for patients with repaired tetralogy of Fallot were found to be generally favorable. All patients undergoing a trial of labor or cesarean delivery had neuraxial analgesia or anesthesia. Recognition and management of congestive heart failure was necessary in 19% of deliveries.
大多数关于法洛四联症手术后妊娠的病例报告都集中在心血管和产科问题上，相对较少的作者关注具体的分娩期和产后麻醉管理策略。
梅奥诊所先天性心脏病诊所和波士顿成人先天性心脏病服务数据库与梅奥诊所和布莱根妇女医院麻醉学数据库交叉引用，以确定 1994 年 1 月 1 日至 2008 年 1 月 1 日期间在各自医院分娩的法洛四联症患者。我们回顾了每个病历，以评估妊娠、分娩和分娩期间的产妇护理，重点是麻醉管理。
在 14 年的研究期间，共发现 20 名法洛四联症修复患者中有 27 例分娩。在 15 名产妇中，有 21 例（78%）尝试了分娩；所有产妇在分娩和分娩中均接受了神经轴镇痛，包括 18 例（86%）硬膜外麻醉、2 例（10%）腰硬联合麻醉和 1 例（5%）在意外硬膜穿刺后连续脊髓麻醉。在 21 名分娩的患者中，有 3 名（14%）接受了有创动脉血压监测；5 名（24%）接受连续遥测；3 名（14%）因充血性心力衰竭需要利尿剂；4 名（19%）有产科或新生儿并发症；和 3 例（14%）有麻醉并发症。由于分娩并发症，4 名患者（19%）需要剖宫产。1 例患者同时出现心血管、产科和麻醉并发症，导致新生儿死亡。6 名（22%）产妇行择期剖宫产；4 例接受硬膜外麻醉，2 例接受脊髓麻醉；无麻醉或即刻产科并发症发生。在所有产妇中，5 名产妇（19%的分娩）在分娩时报告充血性心力衰竭症状。
法洛四联症修复患者的妊娠结局总体良好。所有尝试阴道分娩或剖宫产的患者均接受了神经轴镇痛或麻醉。19%的分娩需要识别和处理充血性心力衰竭。
