Goal-directed fluid therapy and combined spinal-epidural anesthesia in management of pregnant woman with severe aortic stenosis

Abstract

Introduction: In parturients with heart disease, appropriate anesthetic, cardiac, and obstetric collaboration is necessary, especially in those with aortic stenosis (AS). Physiological changes during pregnancy can worsen AS symptoms, causing challenges in obstetric anesthetic management. Patient concerns and diagnosis: A 33-year-old woman with severe AS and progressive orthopnea, 33 weeks pregnant, required a cesarean section due to heart failure. Interventions: We used invasive goal-directed fluid therapy (GDFT) with real-time information on hemodynamic status and a more sophisticated approach to maintain intravascular volume balance. Combined spinal-epidural anesthesia was used under GDFT guidance. Outcomes: The patient underwent cesarean section under combined spinal-epidural with no complications, with a stable newborn status, and was discharged on postoperative day 4. Vasopressors or inotropes were not used during the operation. Conclusion: For cesarean section in severe AS, low-dose sequential spinal anesthesia and slowly titrated epidural anesthesia under GDFT guidance could be a safe way to manage challenging conditions.