Anesthesia for the parturient with cardiovascular disease

Positive maternal and foetal outcomes after cardiopulmonary bypass surgery in a parturient with severe mitral valve disease

“…2,[5][6][7] Survival of healthy infants is as high as 56% post-CPB surgery in parturient women with severe cardiac disease. 8,9 Intraoperative foetal monitoring can help to correct some of the potential hazards 10,11 that result in inadequate foetal oxygen delivery. During CPB surgery in the case study, the haemoglobin values decreased to a minimum of 6.6 g/dl, which could be explained by intraoperative bleeding and haemodilution with subsequent decrease in foetal oxygen delivery.…”

“…2 It is suggested that whenever possible, if the foetus is more than 28 weeks' gestation, strong consideration should be given to delivering the baby prior to valve replacement surgery, as it is a reasonable and safe procedure. 2,8 However, this mainly applies to developed countries or highly resourced institutes with very low maternal and neonatal mortalities related to prematurity. Ultimately, the decision was made to give the foetus a chance to mature further and to operate on the mother, who had the potential to decompensate severely during labour and post partum if surgery was not done soon.…”

“…10 The basic principles of obstetric management were applied: avoiding aortocaval compression by placing a wedge under the right hip, maintaining high maternal inspired oxygen concentration, maintaining intravascular volume, checking arterial blood gases frequently, monitoring the parturient and foetus and providing acid-aspiration prophylaxis. 2,5,8,10 Since the dominant lesion was MS, the anaesthetic management was tailored to avoid tachycardia and pulmonary vasoconstriction, and maintain LV preload without exacerbation of pulmonary vascular congestion. Drugs that cause tachycardia should be avoided.…”

“…It is generally thought that Caesarean delivery should be reserved for obstetric indications only and that the presence of heart disease should not influence that decision. 8 The obstetric approach was also to mature the foetus as far as possible, with a target of 37 weeks, and to avoid complications related to prematurity. Thus, steroids were prescribed for maturation of the foetus's lungs.…”

“…5,7 Untreated maternal heart disease also places the foetus at risk, 2 and if open heart surgery is required, it is best undertaken in the second trimester. 2,6,8 This case study describes positive maternal and foetal outcomes after CPB surgery in a parturient with severe mitral valve disease.…”