title: Evidence-based case report for analgesic and anesthetic management of a parturient with Ebstein's Anomaly and Wolff-Parkinson-White syndrome.
abstract: The rare congenital heart defect of Ebstein's anomaly is characterized by downward displacement and elongation of the septal cusp of tricuspid valve. As a result, it is often associated with a thin-walled and poorly contractile right ventricle, an enlarged atrium, tricuspid regurgitation, atrial septal defect with intracardiac shunt, pulmonary hypertension and tachyarrhythmia. Published reports or studies on analgesic and/or anesthetic management of laboring parturients with Ebstein's anomaly are limited. We present an evidence-based case report of the successful management of an obese laboring parturient with Ebstein's anomaly and Wolff-Parkinson-White syndrome under epidural analgesia. We reviewed the literature and present the best evidence available or its lack of, and the reasoning in supporting the choice of the analgesic and anesthetic management.
authors.affiliation: Department of Anesthesiology, Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA.
authors.forename: V S
authors.initials: VS
authors.lastname: Misa
authors.forename: P H
authors.initials: PH
authors.lastname: Pan
mesh_terms: D000328:Adult; D016362:Analgesia, Obstetrical / Q000379:methods*; D000767:Anesthesia, Epidural / Q000295:instrumentation / Q000379:methods*; D000773:Anesthesia, Obstetrical / Q000379:methods*; D001281:Atrial Fibrillation / Q000503:physiopathology / Q000628:therapy; D004437:Ebstein Anomaly; D019317:Evidence-Based Medicine; D005260:Female; D006801:Humans; D007751:Labor, Induced / Q000379:methods; D008991:Monitoring, Physiologic; D009765:Obesity / Q000150:complications; D011247:Pregnancy; D011249:Pregnancy Complications, Cardiovascular; D011300:Preoperative Care; D014927:Wolff-Parkinson-White Syndrome / Q000151:congenital*