Combined Spinal Epidural Anaesthesia for Emergency Caesarean Section in Patient with Ebstein Anomaly

1 regurgitation or stenosis. It occurs in 1 percent of congenital heart defects. It is associated with either atrial septal defect or patent foramen ovale through which shunting of blood occurs. Haemodynamic derangement depends upon status of tricuspid valve displacement and right to left shunt. Hence, clinical presentation varies from congestive cardiac failure in childhood to incidental diagnosis in adulthood. Though, pregnancy is well tolerated in Ebstein's anomaly, such uncorrected maternal congenital heart defect may have deleterious effects on the health of both the mother and her offspring. Case Report 20 yr old primigravida, 36 weeks of gestation was posted for emergency LSCS for meconeum stained amniotic fluid. In third trimester she was presented with dyspnoea on exertion NYHA grade II and diagnosed as Ebstein anomaly with patent foramen ovale. After cardiac evaluation, she was started on T. Lasix & T. Digitoxin. On clinical examination, pulse120/min, occasional missed beats, BP120/90 mmHg RUL, CVS systolic murmur at tricuspid area, RR24/min, RSclear. There were no signs of congestive cardiac failure such as raised JVP, pitting pedal oedema, hepatomegaly. Her investigations were normal except Hb15.5 (polycythaemia), ECG showing sinus tachycardia with occasional VPCs. 2D ECHOEbstein anomaly of tricuspid valve, TR, dilated RA & RV, PFO, bidirectional shunt, predominantly L R shunt, no PH, normal LV systolic function. ABG on air showed normal pH (7.4), pCO2 (27), but pO2 (58), SO2 (91%) was on lower side and