Perioperative management of a woman with Ebstein's anomaly undergoing caesarean section

Ebstein's anomaly is a rare congenital heart anomaly which poses significant perioperative challenges, particularly in pregnant patients undergoing caesarean section. The condition is marked by apical displacement of the tricuspid valve, causing right atrial enlargement, severe tricuspid regurgitation and an increased risk of arrhythmias and right-sided heart failure.We describe a case of a woman in her 20s with Ebstein's anomaly and severe tricuspid regurgitation who underwent an elective lower-segment caesarean section under epidural anaesthesia. Intraoperative management focused on maintaining haemodynamic stability through invasive monitoring, controlled epidural dosing and judicious fluid administration. The patient remained stable throughout surgery and had an uneventful recovery.This case underscores the need for a multidisciplinary approach, individualised anaesthetic strategies and vigilant perioperative monitoring to ensure safe maternal and fetal outcomes in high-risk cardiac pregnancies.