Anesthetic Management for Cesarean Delivery in a Patient with Severe Aortic Stenosis and Severe Obesity

Abstract

Valvular heart disease has significant effect on the maternal and fetal outcome of pregnancy. The severity and extent of aortic stenosis is of great value for risk assessment and for the design of a therapeutic plan. The therapeutic plan for such patients is further complicated by severe obesity. We report a case describing the anesthetic management of an extremely obese patient for cesarean delivery with severe aortic valve stenosis and regurgitation. The case was made complex due to the patient's deteriorating condition and not offering consent to emergency surgical procedures. The 34-year-old parturient underwent cesarean delivery at 32 weeks gestation under general anesthesia in the presence of a cardiothoracic surgical team. This case report demonstrates the importance of multidisciplinary preoperative assessment in such patients and careful anesthetic planning to avoid the deterioration of perioperative cardiac performance in parturients with complex valvular disease.

Anaesthetic Considerations for Patients with Severe Aortic Stenosis

“…A multidisciplinary approach may be very beneficial in mothers with severe aortic stenosis. The cardiac surgery team in such cases is present during the caesarean section and may take over in case of an emergency [56]. Regardless of the anaesthetic used, blood loss reduces blood volume and to counteract this the uterus contracts and releases additional blood into the circulation.…”