Purpose: To report a case of peripartum dilated cardiomyopathy associated with morbid obesity and possible difficult airway presenting for elective Cesarean section, which was successfully managed with combined spinal-epidural anesthesia.Clinical features: A morbidly obese parturient with a potentially difficult airway, suffering from idiopathic peripartum cardiomyopathy (ejection fraction 20%), was scheduled for an elective Cesarean section.A combined spinal epidural anesthesia was performed and 6 mg of bupivacaine were injected into the subarachnoid space. This was supplemented after 60 min with 25 mg of bupivacaine injected epidurally. The patient's hemodynamic status was monitored with direct intra-arterial blood pressure and central venous pressure measurements. The patient's perioperative course was uneventful. Conclusion:In patients suffering from peripartum cardiomyopathy, undergoing Cesarean section, combined spinal-epidural anesthesia may be an acceptable anesthetic alternative. ERIPARTUM cardiomyopathy occurs in approximately 1/10,000 deliveries 1 and can result in severe ventricular dysfunction during late pregnancy or early puerperium. 2 We present a patient with peripartum cardiomyopathy requiring Cesarean section (CS) who was managed with combined spinal-epidural (CSE) anesthesia.Case report A 25-yr-old, morbidly obese (weight 100 kg, height 1.58 m and body mass index 40) primigravida at 36 weeks gestation, with a Mallampati class IV airway, was scheduled for an elective CS. Two weeks before, she had complained of progressively worsening fatigue and dyspnea with minimal physical activity. A cardiology consultation obtained to evaluate progressively worsening fatigue led to the diagnosis of idiopathic dilated cardiomyopathy. Echocardiography revealed severe left ventricular dysfunction ejection fraction (EF) 20% with moderate pulmonary hypertension and moderate right ventricular dysfunction. Treatment with furosemide, digoxin, and potassium supplemen-OBSTETRICAL AND PEDIATRIC ANESTHESIA

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