Anesthesia Management During Emergency Cesarean Section of A Pregnant Woman with Severe Pulmonary Valve Disease and Previous Surgery Due to Tetralogy of Fallot: A Case Report

Tetralogy of Fallot (TOF) consists of four main components: pulmonary stenosis, ventricular septal defect, right ventricular hypertrophy, and dextroposition and overriding of the aorta. In this presentation, we aim to present the perioperative anesthetic approach to a cesarean section performed under emergency conditions due to preterm labor in a 32-year-old pregnant woman who had undergone surgery for tetralogy of Fallot in childhood. We learned that our patient had surgery at the age of four for tetralogy of Fallot. A previous echocardiogram showed tricuspid annular plane systolic excursion of 18 mm and third-degree tricuspid insufficiency. The patient had severe pulmonary valve insufficiency, with a maximum gradient across the pulmonary valve of 39 mmHg. Spinal anesthesia was administered using 12.5 mg of 0.5% heavy bupivacaine. In addition to standard monitoring, invasive blood pressure monitoring from the left radial artery and central venous pressure monitoring from the left cephalic vein were initiated immediately after spinal anesthesia. No hemodynamic disturbances or adverse events were observed in our patient. In summary, neuraxial analgesia and anesthesia can be safely applied to patients with repaired TOF, and it was the preferred technique for labor analgesia and surgical anesthesia in our patient.