Perioperative Management of a Case of Chronic Rheumatic Heart Disease Posted for Emergency Caesarean Section

Abstract

Rheumatic heart disease(RHD) still remains an endemic in India. It is one of the major causes of mortality and morbidity in parturients in developing countries. We present a 26 year old second gravida with history of chronic rheumatic heart disease with multiple valvular disease. She presented with complaints of palpitations, dyspnoea progressing from New York Heart Association (NYHA) class II to class III. On physical examination, patient was pale, had bilateral pedal edema, tachycardia, dyspnoea, undifferentiated murmur on auscultation. Further evaluation revealed anemia, dilated left atrium, moderate mitral regurgitation, mild mitral stenosis, mild aortic regurgitation and fetal distress. Patient was taken for emergency caesarean section in the view of maternal condition and fetal distress. She developed pulmonary edema during surgery and was kept on ventilator to optimize the patient condition with further management. She was successfully extubated after 3 days of meticulous care in intensive care unit (ICU).