Peripartum cardiomyopathy and cesarean section: report of two cases and literature review

Abstract

We present two cases in which parturients with the diagnosis of peripartum cardiomyopathy presented in congestive heart failure for emergent Cesarean section. Continuous spinal anesthesia and combined spinal-epidural anesthesia were successfully employed as the anesthetic techniques for the procedures. Both patients remained hemodynamically stable during surgery and were discharged home on postoperative days 5 and 4 respectively.

Anaesthetic management of emergency caesarean section in a patient with peripartum cardiomyopathy under general anaesthesia - a case report

“…3,4 Graded epidural anaesthesia has been mostly used because of its better hemodynamic stability. 5,6 Bilenjani et al described caesarean section in a 19-yearold patient at 32 weeks of gestation with PPCM in decompensated heart failure and pulmonary edema. GA was induced with etomidate and remifentanil, and maintained with remifentanil infusion safely, without any adverse outcome on mother or newborn.…”

“…9 GA is used when RA is contraindicated, like in anticoagulated patients and in emergency situations. 5,10 We can use both JSAN 2016; 3 (1)…”

Case Report and Mini Literature Review: Anesthetic Management for Severe Peripartum Cardiomyopathy Complicated with Preeclampsia Using Sufetanil in Combined Spinal Epidural Anesthesia

“…Although PPCM has been reported to occur classically in cases with higher maternal age, parity and African race;1-10,15,21,22,25,32,36-39,41 recently it has been found to occur increasingly in younger age groups, and in primigravida and white mothers as well 5-11,13,14,16,17,19,20,22,23,25,32,35,41-46. Most of the researchers agree that PPCM commonly occurs in twin pregnancies 1,4,5,8,9,13,14,20,25,26,28,37. Preeclampsia and hypertension has been frequently reported to be associated with PPCM cases 1,4-20.…”

“…Patients may present features of severe ventricular dysfunction such as increased left ventricular end diastolic diameter (LVEDD), left ventricular end systolic diameter (LVESD), decreased left ventricular fractional shortening (LVFS) and LVEF, right ventricular dysfunction, valvular regurgitation, regional wall motion abnormality, pulmonary arterial hypertension (PAH) as well as intra cardiac thrombi 2,3,5,7-12,18,21-23,25,26,29,30,35,36,39,41-44. Valvular regurgitant lesions are the consequence of cardiac dilatation 5,26. Magnetic resonance imaging (MRI) and computerized topographic scans are more sensitive diagnostic tools for detection of cardiac thrombus 5,10.…”

“…This is the second tier drug after ACEI/ARB in this regard during the postpartum period 5,28. In severe cases, intravenous nitropruside, nitroglycerin, or nesiritide may be used 5,21,22,26,30,37,41. Nitropruside should be avoided during the antepartum period due to the risk of fetal cyanide toxicity 5,29,30,37.…”