Why the study?
Survival of uncorrected tetralogy of Fallot into adulthood is rare, and the combination of pregnancy, uncorrected tetralogy of Fallot, and shock presents significant anesthetic challenges due to hemodynamic shifts worsening right-to-left shunting.
Highlights the successful multidisciplinary anesthetic management of a rare and high-risk case of uncorrected tetralogy of Fallot in a pregnant patient presenting in shock.
Anesthetic agents may worsen shunting in uncorrected TOF pregnancies with shock; case supports multidisciplinary care but leaves optimal protocols open.
Tetralogy of Fallot (TOF) is the most common form of cyanotic congenital heart disease. The survival of patients with uncorrected TOF till the fourth decade of life is rare (around 3%). Pregnancy in a patient with uncorrected TOF requires a multidisciplinary approach. A confluence of pregnancy, uncorrected TOF and shock is infrequent. The state of hypovolaemia and a decrease in systemic vascular resistance due to anaesthetic agents increase the right to left shunt. The decrease in pulmonary blood flow provokes a 'hypercyanotic spell'. We report the successful management of 30-year-old pregnant (G3P2A2L0) with uncorrected TOF, presenting to the emergency department with incomplete abortion in shock.
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Bellapukonda et al. (2019) studied this question.
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