Anesthetic Consideration for Modified Electroconvulsive Therapy in an Adolescent With Uncorrected Atrial Septal Defect: A Case Report

Catatonia is a serious neuropsychiatric syndrome of motor and behavioral dysfunction where electroconvulsive therapy (ECT) is a well-proven treatment modality. ECT is also preferred as it is a low-risk procedure compared to chronic medications having significant side effects. However, the cardiovascular events that occur during ECT are a major cause of morbidity and mortality in patients with an abnormal cardiovascular pathophysiology. Hence, ECT administration in patients with cardiac diseases remains debatable. Limited literature is present on the use of ECT in a patient with congenital heart disease, especially in uncorrected Atrial Septal Defect (ASD), which is considered a high-risk constellation for an ECT treatment. The goal of anesthetic management in such patients is to maintain pulmonary vascular resistance while slightly reducing the systemic vascular resistance. Currently, modified ECT is performed to reduce the electrical stimulation-related musculoskeletal complications, where the ECT is performed under anesthesia and muscle relaxant. Here we present a case of an 18-year-old male with catatonia with persistent mutism with ASD who underwent six cycles of modified ECT safely. The case highlights the safe use of ECT in uncorrected ASD and the need for a multidisciplinary team.