2026 SOAP Annual Meeting

BACKGROUND

Ebstein anomaly – a rare congenital malformation resulting in apical displacement of the tricuspid valve
Results in a poorly contractile right ventricle, enlarged right atrium, and tricuspid regurgitation
Can lead to right heart failure and cardiac arrhythmias (e.g. WPW syndrome)
Tethered cord syndrome – abnormal tissue attachment to spinal cord
Often associated with spina bifida

CASE

30 YO G1P0000 @ 23w1d presented with PPROM and acute heart failure exacerbation

PMH: Ebstein anomaly, dextrocardia, WPW syndrome, spina bifida occulta with tethered cord syndrome, hepatic cirrhosis, bicornuate uterus

PSH: 3 open-heart surgeries and tricuspid valve replacement x2, dual-chamber pacemaker/ICD placement (DDI mode)
DISCUSSION
- Physiologic effects of pregnancy on cardiac function
- General vs neuraxial anesthesia in high-risk cardiac patients
- Neuraxial in parturient with spinal dysraphism
- Imaging-guided epidural
- Importance of multidisciplinary preoperative planning
- Appropriate monitors and contingency plans
- E.g. availability of procainamide

Anesthetic management of a parturient with Ebstein anomaly and Tethered cord syndrome: A Case Report