Coarctation of the Aorta in Caesarean section: An Anaesthetic challenge

Abstract

Coarctation of the aorta is a narrowing of the aorta resulting from an abnormal junction of the aortic isthmus and the arterial duct. It can present in neonatal period, early childhood or in adulthood and accounts for 5% of all congenital cardiac defects. The maternal mortality for patients with uncorrected coarctation of the aorta is 3% to 9% and fetal mortality may be as high as 20%. A thorough understanding of impact of pregnancy on the heamodynamic response to the patient's cardiac lesion is required for successful anesthetic management. A meticulous approach is needed when planning anaesthesia for Caesarean section in such a case as associated haemodynamic effects of both general and regional anaesthesia can have serious and deleterious effects on both the mother and newborn. We present successful anaesthetic management under graded epidural anaesthesia for elective Caesarean section in a case of unrepaired coarctation of the aorta.

Anaesthesia management of pregnant patient with uncorrected middle aortic syndrome (MAS) for caesarean section

“…There are multiple reports of Regional anaesthesia being used, either epidural alone or combination with spinal for patient with uncorrected CoA. [8][9][10][11] Many anaesthesiologist do not prefer GA due to occurrence of haemodynamic changes during laryngoscopy, intubation and incision. These haemodynamic changes are also can occur during extubation.…”

“…Tadwalkar 8 reported use of graded epidural anaesthesia only for elective Caesarean section in a case of unrepaired coarctation of the aorta. Bourgeade 9 reported a woman with coarctation of aorta for caesarean delivery under spinal-epidural anaesthesia.…”