Anesthetic Management of Cesarean Section in a Grown-Up Congenital Heart Patient with Placenta Previa and Giant Placental Tumor: A Case Report

The patient had complete placenta previa and a giant placental tumor, and had a history of repair for cor triatriatum (CorT) 19 years previously. After anesthetic induction with remifentanil, thiamylal, and rocuronium, tachyarrhythmia occurred following multifocal ventricular premature contraction. Treatment with lidocaine was not effective. However, tachyarrhythmia converted naturally after delivery and removal of the placental tumor. We speculated that the surgical scar remaining after CorT repair acted as an arrhythmogenic substrate, and that these factors associated with hemodynamic change and hypomagnesaemia in this patient, including sympathetic instability of pregnancy, giant placental tumor, and general anesthesia, resulted in unexpected arrhythmia. In conclusion, in cases of caesarian section in grown-up congenital heart pregnant patients with complete placenta previa and giant placental tumor, careful consideration should be given to alterations in the hemodynamic condition.