{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,11,24]],"date-time":"2025-11-24T02:06:17Z","timestamp":1763949977856,"version":"3.45.0"},"reference-count":10,"publisher":"BMJ","issue":"11","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Case Rep"],"accepted":{"date-parts":[[2025,11,3]]},"published-print":{"date-parts":[[2025,11]]},"abstract":"<jats:p>Ebstein\u2019s anomaly is a rare congenital heart anomaly which poses significant perioperative challenges, particularly in pregnant patients undergoing caesarean section. The condition is marked by apical displacement of the tricuspid valve, causing right atrial enlargement, severe tricuspid regurgitation and an increased risk of arrhythmias and right-sided heart failure.<\/jats:p>\n                  <jats:p>We describe a case of a woman in her 20s with Ebstein\u2019s anomaly and severe tricuspid regurgitation who underwent an elective lower-segment caesarean section under epidural anaesthesia. Intraoperative management focused on maintaining haemodynamic stability through invasive monitoring, controlled epidural dosing and judicious fluid administration. The patient remained stable throughout surgery and had an uneventful recovery.<\/jats:p>\n                  <jats:p>This case underscores the need for a multidisciplinary approach, individualised anaesthetic strategies and vigilant perioperative monitoring to ensure safe maternal and fetal outcomes in high-risk cardiac pregnancies.<\/jats:p>","DOI":"10.1136\/bcr-2025-266411","type":"journal-article","created":{"date-parts":[[2025,11,24]],"date-time":"2025-11-24T02:05:12Z","timestamp":1763949912000},"page":"e266411","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":0,"title":["Perioperative management of a woman with Ebstein\u2019s anomaly undergoing caesarean section"],"prefix":"10.1136","volume":"18","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-8933-3295","authenticated-orcid":false,"given":"Shashank","family":"Kumar","sequence":"first","affiliation":[{"name":"Anaesthesiology, King George\u2019s Medical University, Lucknow, UP, India"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jaideep","family":"P","sequence":"additional","affiliation":[{"name":"Anaesthesiology, King George\u2019s Medical University, Lucknow, UP, India"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Neel Kamal","family":"Mishra","sequence":"additional","affiliation":[{"name":"Anaesthesiology, King George\u2019s Medical University, Lucknow, UP, India"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6449-5263","authenticated-orcid":false,"given":"Shefali","family":"Gautam","sequence":"additional","affiliation":[{"name":"Anaesthesiology, King George\u2019s Medical University, Lucknow, UP, India"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2025,11,23]]},"reference":[{"key":"2025112318050816000_18.11.e266411.1","doi-asserted-by":"crossref","first-page":"1101","DOI":"10.1586\/14779072.2015.1087849","article-title":"Ebstein anomaly review: what\u2019s now, what\u2019s next?","volume":"13","author":"Dearani","year":"2015","journal-title":"Expert Rev Cardiovasc Ther"},{"key":"2025112318050816000_18.11.e266411.2","doi-asserted-by":"crossref","DOI":"10.1136\/openhrt-2023-002406","article-title":"Pregnancy outcomes in women with Ebstein\u2019s anomaly: data from the Registry of Pregnancy And Cardiac disease (ROPAC)","volume":"10","author":"van der Zande","year":"2023","journal-title":"Open Heart"},{"key":"2025112318050816000_18.11.e266411.3","doi-asserted-by":"crossref","first-page":"73","DOI":"10.1016\/j.ijoa.2018.09.011","article-title":"Obstetric anesthesia management of the patient with cardiac disease","volume":"37","author":"Arendt","year":"2019","journal-title":"Int J Obstet Anesth"},{"key":"2025112318050816000_18.11.e266411.4","doi-asserted-by":"crossref","first-page":"370","DOI":"10.1177\/0310057X0903700314","article-title":"Anaesthesia and right ventricular failure","volume":"37","author":"Forrest","year":"2009","journal-title":"Anaesth Intensive Care"},{"key":"2025112318050816000_18.11.e266411.5","doi-asserted-by":"publisher","DOI":"10.1016\/0735-1097(94)90610-6"},{"key":"2025112318050816000_18.11.e266411.6","doi-asserted-by":"publisher","DOI":"10.1161\/CIR.0000000000000458"},{"key":"2025112318050816000_18.11.e266411.7","first-page":"4578","article-title":"Antiarrhythmic Drug Use in Pregnancy: Considerations and Management","volume":"13","author":"Mariani","year":"2024","journal-title":"J Clin Med"},{"key":"2025112318050816000_18.11.e266411.8","first-page":"275","article-title":"Transfusion and coagulation management in major obstetric hemorrhage","volume":"28","author":"Butwick","year":"2015","journal-title":"Clin Obstet Gynecol"},{"key":"2025112318050816000_18.11.e266411.9","doi-asserted-by":"crossref","first-page":"390","DOI":"10.1016\/j.acvd.2016.01.010","article-title":"Clinical characteristics and outcomes in pregnant women with Ebstein anomaly at the time of delivery in the USA: 2003-2012","volume":"109","author":"Lima","year":"2016","journal-title":"Arch Cardiovasc Dis"},{"key":"2025112318050816000_18.11.e266411.10","doi-asserted-by":"crossref","first-page":"452","DOI":"10.1016\/j.ajog.2013.07.005","article-title":"Risk factors for maternal and fetal outcome in pregnancy complicated by Ebstein anomaly","volume":"209","author":"Katsuragi","year":"2013","journal-title":"Am J Obstet Gynecol"}],"container-title":["BMJ Case Reports"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bcr-2025-266411","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,11,24]],"date-time":"2025-11-24T02:05:14Z","timestamp":1763949914000},"score":1,"resource":{"primary":{"URL":"https:\/\/casereports.bmj.com\/lookup\/doi\/10.1136\/bcr-2025-266411"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,11]]},"references-count":10,"journal-issue":{"issue":"11","published-online":{"date-parts":[[2025,11,23]]},"published-print":{"date-parts":[[2025,11]]}},"alternative-id":["10.1136\/bcr-2025-266411"],"URL":"https:\/\/doi.org\/10.1136\/bcr-2025-266411","relation":{},"ISSN":["1757-790X"],"issn-type":[{"value":"1757-790X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,11]]}}}