Anesthetic management for emergency cesarean section and aortic valve replacement in a parturient with severe bicuspid aortic valve stenosis and congestive heart failure

Abstract

Asymptomatic women with mild aortic stenosis (AS) and normal left ventricular functions can successfully carry pregnancy to term and have vaginal deliveries. However, severe AS (valve area <1.0 cm2) can result in rapid clinical deterioration and maternal and fetal mortality. So, these patients require treatment of AS before conception or during pregnancy preferably in the second trimester. In suitable patients percutaneous balloon aortic valvotomy appears to carry lower risk. It can also be used as a palliative procedure allowing deferral of aortic valve replacement until after delivery. The present patient had severe critical AS with congestive heart failure that was refractory to medical therapy and the fetus was viable (>28 wks). So, combined lower segment cesarean section and aortic valve replacement were performed under opioid based general anesthesia technique to reduce the cardiac morbidity and mortality.

Anesthetic Management of a Voluminous Left Atrial Myxoma Resection in a 19 Weeks Pregnant with Atypical Clinical Presentation

“…In order to provide adequate utero-placental perfusion and to guarantee fetal protection [23,24], current recommendations suggest: high perfusion pressure (>70 mmHg), high flow (2.5 L/min/m 2 ), and pulsatile, normothermic CPB [19,22]. Maternal hematocrit >28% is also recommended for optimizing oxygen transfer [23] and a-Stat pH management, in order to protect the fetus against hypocapnia and uteroplacental vasoconstriction [4].…”

Anaesthetic management of a patient with severe aortic stenosis for caesarean section: a case report

“…Despite the risk of fetal depression, in the interest of maternal safety opioid based induction can be used. 9 We used fentanyl and titrated low dose of thiopentone for induction to achieve hemodynamic stability. Tachycardia is deleterious in these patients as it decreases diastolic filling time and should be treated promptly using beta blockers.…”

Pregnancy in a Patient With Severe Aortic Stenosis Requiring Unusual Management

“…Both events could have led to refractory hypotension, a highrisk situation for both the mother and the fetus. [27][28][29][30][31] Leftward decubitus can minimize the effect of caval compression and can improve preload. 32 The patient must also be monitored carefully for increased blood volume and hypertensive crises, which dramatically can increase left ventricular filling pressures, resulting in pulmonary edema.…”