Anesthetic Care of the Pregnant Patient With Cardiovascular Disease: A Scientific Statement From the American Heart Association

Abstract

The pregnancy-related mortality rate in the United States is excessively high. The American Heart Association is dedicated to fighting heart disease and recognizes that cardiovascular disease, preexisting or acquired during pregnancy, is the leading cause of maternal mortality in the United States. Comprehensive scientific statements from cardiology and obstetrics experts guide the treatment of cardio-obstetric patients before, during, and after pregnancy. This scientific statement aims to highlight the role of specialized cardio-obstetric anesthesiology care, presenting a systematic approach to the care of these patients from the anesthesiology perspective. The anesthesiologist is a critical part of the pregnancy heart team as the perioperative physician who is trained to prevent or promptly recognize and treat patients with peripartum cardiovascular decompensation. Maternal morbidity is attenuated with expert anesthesiology peripartum care, which includes the management of neuraxial anesthesia, inotrope and vasopressor support, transthoracic echocardiography, optimization of delivery location, and consideration of advanced critical care and mechanical support when needed. Standardizing the anesthesiology approach to patients with high peripartum cardiovascular risk and ensuring that cardio-obstetrics patients have access to the appropriate care team, facilities, and advanced cardiovascular therapies will contribute to improving peripartum morbidity and mortality.

Anesthetic management for cesarean section in two parturient with ascending aortic aneurysm: a case-based discussion

“…Another way to avoid the respiratory depression in neonate is to reduce the use of opioids in parturient, which could be done by applying neuroaxial, instead of general anesthesia. Neuroaxial modes (spinal and epidural anesthesia) are reported to be preferred types of anesthesia for caesarean section, including for patients with aortic lesions [ 30 ], as in our patients. The first choice for both patients would thus be providing a spinal anesthesia.…”

“…However, the first patient refused it and in the second we decided to conduct general anesthesia, mainly because of concerns on failure of spinal anesthesia in patients with connective tissue disorders [ 1 – 3 ]. Regardless of the type of anesthesia, it is priority to maintain hemodynamic stability by avoiding an increase of systemic vascular resistance (which increase aortic sheer stress) and hypotension (which endangers fetal perfusion) [ 30 ].…”

Manajemen Anestesi pada Pasien Obstetri dengan Kelainan Jantung Kongenital dan Risiko Hipertensi Pulmonal

“…4 Pendekatan multidisiplin dilakukan dengan tujuan untuk meningkatkan pemahaman penyakit jantung pada kehamilan dan merencanakan koordinasi perawatan multidisiplin untuk mengurangi komplikasi peripartum dan postpartum. 5 Konseling prakonsepsi, stratifikasi risiko dan edukasi, koordinasi multidisiplin, dan perencanaan yang cermat harus dilakukan oleh tim multidisiplin. 5 Peran anestesi sangat penting pada manajemen pasien perioperatif dalam keberhasilan tim multidisiplin untuk mendapatkan luaran yang baik.…”

“…5 Konseling prakonsepsi, stratifikasi risiko dan edukasi, koordinasi multidisiplin, dan perencanaan yang cermat harus dilakukan oleh tim multidisiplin. 5 Peran anestesi sangat penting pada manajemen pasien perioperatif dalam keberhasilan tim multidisiplin untuk mendapatkan luaran yang baik. Keberhasilan manajemen pasien perioperatif pada pasien dengan hipertensi pulmonal memerlukan beberapa langkah, diantaranya yaitu mengenali permasalahannya, mendiagnosis penyebabnya, menilai tingkat keparahan penyakit, menilai risiko dan manfaat anestesi serta pembedahan, mengembangkan rencana anestesi, dan mengelola komplikasi perioperatif seperti hipotensi sistemik dan gagal jantung kanan.…”

“…Namun sebagian besar pasien dengan penyakit jantung dapat melalui kehamilan dan persalinan dengan aman selama mendapatkan perawatan yang baik. 5…”