Key result
Neuraxial analgesia or anesthesia was used in all 27 deliveries among 20 parturients with repaired tetralogy of Fallot, yielding generally favorable outcomes despite a 19% rate of congestive heart failure.
Case Report (n=20)
Yes
Neuraxial analgesia and anesthesia are generally safe and commonly used in parturients with repaired tetralogy of Fallot, though congestive heart failure requires management in nearly one-fifth of deliveries.
Answers are grounded in this paper and cite their sources.
Supports neuraxial use in repaired TOF parturients; leaves open need for larger prospective confirmation before practice change.
BACKGROUND: 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. METHODS: 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. RESULTS: 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. CONCLUSIONS: 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.
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Arendt et al. (2011) conducted a case report in Pregnancy in patients with surgically repaired tetralogy of Fallot (n=20). Anesthetic management (neuraxial analgesia/anesthesia) was evaluated on Pregnancy outcomes and anesthetic complications. Neuraxial analgesia or anesthesia was used in all 27 deliveries among 20 parturients with repaired tetralogy of Fallot, yielding generally favorable outcomes despite a 19% rate of congestive heart failure.
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