Saini Vikas, Samra Tanvir, Kaur Gurpreet
Department of Anaesthesia and Intensive Care, Post Graduate Institute of Medical Education and Research, Chandigarh, India.
J Anaesthesiol Clin Pharmacol. 2017 Oct-Dec;33(4):544-546. doi: 10.4103/0970-9185.173342.
A 25-year-old female with congenitally corrected transposition of great arteries (CCTGAs), atrial septal defect, and severe pulmonary stenosis underwent lower segment cesarean section at 34 weeks of gestation using combined spinal epidural anesthesia (CSEA). We used transthoracic echocardiography (TTE) for intraoperative monitoring of the cardiovascular system because these patients are reported to have a high prevalence of myocardial perfusion defects, regional wall motion abnormalities, and impaired ventricular contractility. Scanning was done at four different time intervals; preoperatively, after initiation of CSEA, after delivery of child and postoperatively (6 and 24 h postdelivery) to detect regional wall motion and valvular abnormalities, calculate ejection fractions and optimize fluid administration. In this case report, we thus discuss the anatomical defects of CCTGA, physiologic concerns and emphasize on the use of TTE for perioperative management of such cases.
一名25岁患有先天性矫正型大动脉转位（CCTGA）、房间隔缺损和严重肺动脉狭窄的女性，在妊娠34周时采用腰麻-硬膜外联合麻醉（CSEA）进行了下段剖宫产术。我们使用经胸超声心动图（TTE）对心血管系统进行术中监测，因为据报道这些患者心肌灌注缺损、局部室壁运动异常和心室收缩功能受损的发生率很高。在四个不同的时间间隔进行扫描，即术前、CSEA开始后、胎儿娩出后以及术后（产后6小时和24小时），以检测局部室壁运动和瓣膜异常，计算射血分数并优化液体管理。在本病例报告中，我们因此讨论了CCTGA的解剖缺陷、生理问题，并强调了TTE在此类病例围手术期管理中的应用。
