Anesthetic management of a pregnant patient with congenitally corrected transposition of the great arteries for labor and vaginal delivery

A patient with congenitally corrected transposition of the great arteries (CCTGA), which is a rare form of congenital heart disease that is characterized by discordant atrioventricular and ventriculoarterial connections, was admitted for induction of labor at 40 weeks' gestation. This patient was first diagnosed with CCTGA at 20 weeks' gestation and had experienced recurrent supraventricular tachycardia (SVT) during her pregnancy. An early epidural infusion of local anesthetic and opioid was administered to decrease maternal catecholamine release and prevent tachycardia associated with labor pain. Noninvasive blood pressure, continuous lectrocardiography, and pulse oximetry were monitored, and supplemental oxygen was provided. Various cardiac medications were made immediately available to promptly treat a SVT if necessary. The patient remained hemodynamically stable throughout labor and vaginal delivery. The anatomical defects of CCTGA, associated conditions, physiologic concerns, and treatment options are reviewed.