Management of pulmonary arterial hypertension during pregnancy

Krishnathasan, Kaushiga; Constantine, Andrew; Rafiq, Isma; Pires, A; Douglas, Hannah; Price, Laura; Dimopoulos, Konstantinos

doi:10.1080/17476348.2023.2210838

Cited by 2 publications

(1 citation statement)

References 74 publications

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“…Pregnancy also leads to inherent increases in blood volume, minute ventilation and cardiac output, via elevated heart rate and stroke volume, starting in the first trimester. These physiological changes can further exacerbate RV strain and PVR, further complicating the choice of primary anaesthetic 7–9. Intraoperative care for severe PH patients should occur at heart centres with the ability to institute mechanical circulatory support, if necessary.…”

Section: Discussionmentioning

confidence: 99%

Anaesthetic management of a patient with severe pulmonary hypertension, moderate tricuspid regurgitation and moderate right ventricular dysfunction presenting for a dilation and curettage

Anderson,

Grell,

Haines

2024

BMJ Case Rep

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A primigravida woman in her 30s with severe pulmonary hypertension, tricuspid regurgitation and depressed right ventricular function presented for therapeutic termination of pregnancy at 7 weeks gestation after referral and multidisciplinary recommendation. A slowly titrated lumbar epidural was chosen for the primary anaesthetic. Under standard American Society of Anesthesiologists (ASA) monitoring, invasive blood pressure monitoring and continuous transthoracic echocardiography, the patient’s right ventricular systolic function was monitored throughout the case using qualitative and quantitative metrics and was notable for a right ventricular systolic pressure of 102.4 mm Hg. Milrinone, started prior to epidural titration, was used for inotropic support. Vasopressin was used in conjunction to sustain systemic vascular resistance while having little effect on the pulmonary vascular resistance. The patient experienced no complications or exacerbation of her pulmonary hypertension and was discharged home the following day.

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Section: Discussionmentioning

confidence: 99%