2026 SOAP Annual Meeting

Tethered Spinal Cord in a Parturient with ccTGA Requiring General Anesthesia

Manrit Gill MD, Terry Biel MD MBA Oregon Health & Science University gillma@ohsu.edu

26F G1P0 37w3d, BMI 21.84, 49.9kg 132 cm (4'4)

- Congenitally corrected Transposition of Great Arteries

- complete situs inversus totalis with dextrocardia

- Complete heart block w single chamber pacemaker – 100% V-paced

- Residual VSD

- Tethered spinal cord with Neurogenic bladder

- Hip dysplasia w limited mobility

- CARPREG II Score 5 (arrythmia, LVEF < 55%); 41% probability peripartum cardiac event

- Planned primary C-section under GA

PreOp

- Neuraxial contraindicated (tethered cord)

- Multidisciplinary planning: anesthesia, maternal-fetal medicine, cardiology, electrophysiology

- No O2 requirements, mild peripheral edema (nml preg). No new changes to activity tolerance

- Pacemaker asynchronous mode, VOO Labs/Imaging

- Echo: Mildly enlarged morphologic right ventricular size (systemic ventricle), EF 43%, mod AV reg (morphological TR). Unable to est LVSP.

- Cardiac Index 3.25

- H/H 12.4/37.5 Plt 129. Cr. 0.64

- Standard monitors, PIV x2

- Induction: RSI with 100mg propofol and 100mg succinylcholine.

- Atraumatic 5.5 ETT, Glidescope (one attempt) - EBL ~760 mL, stable vital signs throughout

- TAP blocks for postop analgesia

Post Op

- PACU recovery uncomplicated, Pacemaker returned to baseline, Tele x 48h without events, DC home on POD 3

DISCUSSION

- Tethered cord may preclude neuraxial even in high risk cardiac disease

- Systemic RV physiology increases anesthetic risk oHigh maternal mortality, hospitalizations, heart failure, arrhythmias

- General anesthesia is viable

- Importance of multidisciplinary planning

Tethered Spinal Cord Precluding Neuraxial Anesthesia in a Parturient with Congenitally Corrected Transposition of the Great Arteries