2026 SOAP Annual Meeting

EMERGENT CESAREAN SECTION IN A PARTURIENT WITH AN UNBALANCED ATRIOVENTRICULAR (AV) CANAL DEFECT STATUS POST COMPLETE REPAIR.

ALEXIA GAGLIARDI, MD, IRINA CHUGAIEVA, MD, JOHN CAHIR, MD, SUSANNE RUPERT, MD

BACKGROUND

•Glenn procedure: anastomosis of the superior vena cava (SVC) to the pulmonary artery (PA) to relieve cyanosis due to congenital heart defects

•AV canal defect repair: separation of a single AV canal into proper right and left components

•Glenn physiology: passive blood flow from the SVC to PA

•Preload dependent

•Requires low pulmonary vascular resistance (PVR)

THE CASE

•A 30 y/o G1P0 with congenitalunbalanced AV canal defect s/p definitive repair with modified, bidirectional Glenn – SVC to right PA anastomosis and reconstructed right and left AV valves

•ECHO: mildly reduced function, mild bilateral AV valve stenosis with moderate regurgitation.

•Modified WHO Class was II-III. Functional status I.

•At 37 weeks: category II FHR with persistent fetal bradycardia

•Emergent C-section with general anesthesia (propofol, phenylephrine infusion, 5-mg boluses ephedrine, vasopressin available)

•ETO2 maintained < 30 mmHg, PEEP limited to 5 mmHg

•IVFs: 1200 mL of LR, EBL: 450 mL

LEARNING POINTS

•Pre-load dependent physiology in the setting of emergent c-section

•Potential compromise to pre-load:

•IVC compression avoided with left uterine displacement, blood loss, PPV

•Low dose phenylephrine primary vasopressor (SVR>PVR) - vasopressin available

•Minimize PVR: avoid hypoxia/hypercarbia

•optimal TV, optimal PEEP (5)

2026 SOAP Annual Meeting

Emergent cesarean section in a parturient with an unbalanced atrioventricular (AV) canal defect status post complete repair.

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