[A Case of Combined Spinal-Epidural Anesthesia for Cesarean Section in a Patient with Right Heart Failure due to Supravalvular Pulmonary Stenosis after Jatene Operation].

: In a 30-year-old pregnant woman with supravalvular pulmonary stenosis after Jatene operation, the right ventricular and pulmonary artery pressure were 54/4 and 30/10 mmHg respectively in the non-pregnant condition. She was hospitalized due to pregnancy induced hypertension at 37 weeks of gestation. At the end of pregnancy, right ventricular failure occurred due to the increased circulatory plasma volume. Induc- tion of delivery was started at 37 weeks 6 days. How- ever, emergency cesarean section was planned because of maternal fatigue and uterine inertia. It was expected that airway management might be difficult because of obesity and full stomach. We chose combined spinal and epidural anesthesia. To avoid rapid reduction of systemic vascular resistance, we selected 0.5% isobaric bupivacaine 1.9 ml and fentanyl 10 gg for spinal anesthesia. Because inadequate analge- sia might worsen right ventricular failure, we added epidural anesthesia. The loss of cold sensation had reached at the fifth thoracic dermatomal level. The hemodynamics was stable without vasopressors. The continuous infusion of 0.2% ropivacaine from epidural catheter was started immediately after the delivery of the baby. As the result of choosing the appropriate anesthesia method, type and amount of local anesthetic, we succeeded in anesthetic management of this patient with right ventricular failure.