Anesthesia for Cesarean section in a patient with a transposition of great arteries--case report

Transposition of great arteries (TGA) is one of the mixing lesions between right and left side with a prevelance of 0.21 per 1,000 live births. A 25 years old lady from KSA, Gravida 3, Para 1 + 1, at 34 weeks gestational age was admitted to KAUH with symptoms suggestive of heart failure (NYHA Class IV). She was born with congenitally corrected TGA and coarctation of the aorta for which she under went several operations, the last one of which was tricuspid valve replacement, she being on chronic anti-coagulation. On hospital admission, she was treated with anti-failure measures with stoppage of the oral anti-coagulant intake and shift to I.V. heparin. Cesarean section was performed under subarachnoid block using 2 ml of hyperbaric bupivacaine 0.5% with several precautions to avoid abrupt decrease in the systemic vascular resistance. Baby was delivered with APGAR score 10 after 5 minutes. Postoperatively, the patient was admitted to the ICU for monitoring of the vital signs, and subcutaneous heparin was resumed immediately.