Anesthetic management of cesarean delivery in parturients with ruptured sinus of Valsalva aneurysm

Abstract

Rationale:Ruptured sinus of Valsalva aneurysm is rare and dangerous in parturients. Few cases of ruptured SVA in pregnancy are reported, and the anesthetic management for cesarean delivery has scarcely been described.Patient concerns:A parturient at 37-week gestation complained of a sore throat and cough that started 3 days before admission, followed 1 day later by fever, dizziness, breathlessness, and palpitation on exertion. Case two at 36-week gestation complained of a 1-day history of bloating in the lower abdomen.Diagnoses:Full term and preterm parturients with ruptured sinus of Valsalva aneurysm.Interventions:Cesarean deliveries were performed with incremental epidural anesthesia technique under invasive monitoring. Surgical correction of the ruptured sinus of Valsalva aneurysms and ventricular septal defect were performed uneventfully 13 days and 7 days postpartum, respectively, for the 2 cases.Outcomes:No complications were observed in the intra- or postoperative period for both mothers and babies.Lessons:We reviewed the pertinent literature and reached the following conclusions: use of a multidisciplinary team to guide anesthetic management is helpful and necessary; and both general anesthesia and incremental epidural anesthesia can be safely used in parturients with ruptured sinus of Valsalva aneurysm.

Emergency Cesarean Section in a Parturient with Ruptured Sinus of Valsalva under Spinal Anesthesia: A Case Report

“…1 In the case at hand, echocardiographic assessment reveals a shunt from the highpressure circulatory system into the low-resistance pulmonary circulation, resulting in observable signs of volume and pressure overload during echocardiography. 3,4,11 To anticipate events that may lead to hemodynamic compromise, it is crucial to correlate this information with the physiological adaptations occurring during pregnancy. 12 Upon admission, the patient did not present with signs of congestion.…”

“…This promotes forward flow and reduces volume load on the right side of the heart. 3,4,7 Several reports argue that epidural anesthesia is preferable to spinal anesthesia in patients with RSOV undergoing a cesarean section due to the more controlled sympathectomy provided by the former. 3,4 However, it is important to note that epidural anesthesia has a disadvantage of delayed onset, which is less ideal in emergent deliveries.…”

“… 10 Documented anesthetic management of patients who underwent cesarean section is fewer, with most cases reporting a planned abdominal delivery under epidural anesthesia. 3 , 4 , 7 Review of the literature from 2010 to 2022 yielded only one report of an elective case done under general anesthesia and one under spinal anesthesia. 7 , 11 As of this writing, there is limited literature available regarding the anesthetic management of obstetric patients with uncorrected RSOV for emergent delivery.…”

“…1 The anatomy and speed of which will determine its course, hemodynamic consequences, and prognosis. 1,[3][4][5] In the non-pregnant patient, a Ruptured Sinus of Valsalva (RSOV) produces varying degree of symptoms, from mild to severe symptoms of congestive heart failure to symptoms of ischemic heart disease, arrhythmia, and even tamponade. [5][6][7] If the ruptured sinus is left untreated, the prognosis is poor, with life expectancy of one year depending on the degree and site of rupture.…”

Transthoracic minimally invasive closure for the treatment of ruptured sinus of Valsalva aneurysm: immediate and mid-term follow-up results

“…Although we did not treat pregnant patients with aortic sinus aneurysm rupture, we believe that TMIC is a good alternative for patients with RSVA in earlier pregnancy according to the studies (28,29).…”