Anesthetic Management

By in Anaesthesiology Cardiology

Nov 23, 2018

Anesthetic Management of a Severe Cardiac Patient Undergoing Cesarean Section

Rheumatic heart disease is a significant challenge in the management of pregnant patients requiring surgical delivery. This chronic condition, characterized by valvular fibrosis, stenosis, and/or regurgitation, can lead to life-threatening complications during the peripartum period.

In this case report, we present the successful anesthetic management of a 30-year-old female with severe rheumatic heart disease who underwent cesarean section at 37 weeks of gestation.

The patient had a history of rheumatic fever and had previously undergone percutaneous mitral valvuloplasty in 2009. Her preoperative echocardiogram revealed severe mitral stenosis (mitral valve area <1 cm2), moderate mitral regurgitation, and severe pulmonary hypertension. Her cardiac function was significantly compromised, with an ejection fraction of 55%.

Given the high-risk nature of this case, a multidisciplinary approach involving experienced obstetricians, cardiologists, and anesthesiologists was crucial. After comprehensive preoperative optimization, general anesthesia was chosen over regional anesthesia to better control the patient’s hemodynamics during the procedure.

Intraoperatively, we employed invasive arterial monitoring to closely track the patient’s blood pressure. A combination of anesthetic agents, including etomidate, fentanyl, and sevoflurane, was used to maintain hemodynamic stability. Special attention was paid to avoiding factors that could exacerbate pulmonary hypertension, such as hypercarbia, acidosis, and hypoxemia.

The patient remained hemodynamically stable throughout the surgery, and both the mother and the baby tolerated the procedure well. Postoperative care included monitoring in the cardiac care unit, and the patient was discharged on the fourth day in satisfactory condition.

The successful management of this high-risk case highlights the importance of a multidisciplinary approach and the expertise available at specialized cardiac centers like Metro Heart Institute and Multispecialty Hospital in Faridabad, Delhi-NCR. By leveraging advanced monitoring and anesthetic techniques, we were able to navigate the unique challenges posed by severe rheumatic heart disease in a pregnant patient and ensure a favorable outcome for both the mother and the newborn.