{
  "abstract": "Background and Aims Cardiovascular disease (CVD) is the leading cause of pregnancy-related mortality in the United States. The mortality incidence from 1987 & 2015 increased from 7.2 to 17.2 deaths/100,000 live births due to multiple reasons. Aim: How to manage a high-risk obstetric cardiac case coming for an emergency Cesarean Section in a resource-limited night call. Secondary aims are: To minimize changes in preload, maintain preload to ensure pulmonary blood flow, avoid fluid overload, maintain low to normal PVR to encourage pulmonary blood flow, and to avoid sedation, hypoxia, and hypercarbia.Methods 24 years G1P0 at 37 weeks, History of Hypoplastic left heart syndrome with Fontan. She endorses significant exertional dyspnea and a single episode of chest pain recently. Taking Aspirin 81 mg and Enoxaparin 40 mg daily. The action plan included examination, checking of investigations, consultations, and labor analgesia plan, as well as post-procedure disposal. Goals include baseline and regular echocardiogram, and if general anesthesia is needed, the plan was to limit inspiratory pressure and PEEP and adequate minute ventilation to maintain low PVR.Results We did a titrated epidural and an arterial line for a cesarean section. The patient was stable during the intra-op period with vasopressor support and transferred to the ICU after the emergent section.Conclusions Multidisciplinary care is essential to optimizing outcomes for mothers with CVD, and care plans should be distributed to all team members and kept in a location easily accessible to obstetric and anesthesia providers, nurse management, and consulting services (Cardiology, neonatology, CV surgery). Anesthesia providers play an integral role in care planning through postpartum care. When possible and safe, neuraxial anesthesia can successfully provide for pain-free and hemodynamically stable delivery experiences and is preferable to general anesthesia.",
  "authors": [
    {
      "affiliations": [
        "Anesthesia, Washington University School of Medicine Saint Louis, Saint Louis, USA"
      ],
      "name": "Sennaraj Balasubramanian"
    },
    {
      "affiliations": [
        "Anesthesia, Washington University School of Medicine Saint Louis, Saint Louis, USA"
      ],
      "name": "Swarup Varaday"
    }
  ],
  "title": "EP204 Emergency cesarean section under neuraxial anesthesia for a ‘left hypoplastic heart syndrome’ patient with fontan",
  "uid": "4f13f748-0ce1-5084-8de3-e539e889a8ad"
}