Anaesthetic management of a parturient with severe mitral stenosis and pulmonary hypertension for caesarean section

Abstract

Pregnancy itself is a stressful period for women which gets further compounded by the presence of mitral stenosis (MS). The interaction between the hyperdynamic cardiovascular changes of pregnancy, i.e. increased cardiac output, increased heart rate and increased oxygen consumption and the narrowed mitral valve are to be understood to avoid the complications occurring during labour and delivery. Pulmonary hypertension (PH) is rarely seen in pregnancy but can result in high maternal mortality secondary to increased risk of congestive heart failure, arrhythmia and sudden cardiac arrest. In this report, we discuss the management of a case of severe MS compounded with PH requiring caesarean section. Case reportA 25-year-old, 38 +4 weeks gestation G 1 P 0 with known rheumatic heart disease and severe MS was scheduled for elective caesarean section (CS) in view of intrauterine growth restriction and severe oligohydramnios. Her first trimester was uneventful. In second trimester, she developed fever and breathlessness for which she presented to the obstetric department and was managed conservatively with antipyretics and analgesics and was discharged home in stable condition. No cardiology opinion was taken at the time. She again developed cough and breathlessness in third trimester. A complete cardiological evaluation was done. Her echocardiography revealed severe MS with severe PH. Balloon mitral c u r r e n t m e d i c i n e r e s e a r c h a n d p r a c t i c e x x x ( 2 0 1 5 ) x x x -x x x Available online xxx Keywords: Anaesthesia Parturient Mitral stenosis Caesarean section Invasive blood pressure monitoring a b s t r a c tMitral stenosis is the most common valvular heart disease seen during pregnancy. Conception is discouraged because of increased morbidity and mortality in cases where pulmonary hypertension develops during the course of mitral stenosis. We present the anaesthetic management of a 25-year-old 38 +4 weeks parturient with severe mitral valve stenosis and pulmonary hypertension. We preferred invasive blood pressure monitoring to observe early haemodynamic changes and arterial blood gas analysis, so that necessary interventions could be taken at the earliest.Please cite this article in press as: Gupta AK, et al. Anaesthetic management of a parturient with severe mitral stenosis and pulmonary hypertension for caesarean section, Curr Med Res Pract. (2015), http://dx.