Anesthetic Management of a Unique Case of Double-Outlet Right Ventricle With Glenn Shunt for Cesarean Delivery: A Case Report.

Double-outlet right ventricle is a rare congenital cardiac anomaly resulting in intracardiac mixing of oxygenated and deoxygenated blood. Surgical palliation involves staged conversion to Fontan circulation, with an intermediate stage using a Glenn shunt. We report the case of a patient at 36 weeks of gestation, with a partially palliated double-outlet right ventricle and a Glenn shunt, who presented with severe dyspnea and worsening cyanosis. After preoperative optimization, a combined spinal-epidural technique was successfully used for cesarean delivery. The anesthetic concerns and perioperative management of patients with complex cardiac physiology are discussed in this report. Carefully titrated combined spinal-epidural technique can be safe and effective for such cases.