Anaesthesia Management of a Patient with Large Atrial Septal Defect with Moderate Pulmonary Hypertension for Total Abdominal Hysterectomy

Atrial septal defect (ASD) is a common cardiac anomaly that may be first encountered in the adults and occurs more frequently in females. ASD accounts for 10% of congenital cardiac defects in adults. A 50 year old female patient posted for Total Abdominal Hysterectomy was diagnosed to have ostium secundum large ASD with mild tricuspid regurgitation with moderate pulmonary hypertension and mild essential hypertension. We report the successful management of the case using combined general anaesthesia with Bilateral Transversus Abdominis plane (TAP) block for postoperative analgesia. During the general anesthesia for the procedure our objectives were to avoid hypotension, hypoxemia, hypercarbia, hypothermia, reversal of shunt and fluid overload and postoperative analgesia by TAP block, The patient had an eventful perioperative course and discharged from the hospital on the 5th-postoperative day in good physical condition.