Anaesthetic management of a parturient with pulmonary stenosis and aortic incompetence for Caesarean section

Abstract

Anaesthetic management of Caesarean section in a parturient with severe pulmonary stenosis and aortic regurgitation is described. The valvular sequelae resulted from previous unsuccessful surgical correction (Ross procedure) of congenital aortic stenosis. This case demonstrates the importance of multi-disciplinary assessment and careful anaesthetic planning, to avoid deterioration in perioperative cardiac performance in parturients with complex valvular disease.

Caesarean delivery in a parturient with a femoro-femoral crossover graft and congenital aortic stenosis repaired by the Ross procedure

“…13 Anaesthetic management of any GUCH parturient begins with an understanding of the underlying congenital lesion, any surgical interventions undertaken, and the respective functional sequelae. 10 The GUCH parturient's physiology is often complex and the response to pregnancy, labour and delivery as well as anaesthetic interventions is uncertain. Meticulous individual assessment using multidisciplinary expertise combined with close, and often invasive, maternal and fetal monitoring, can assist in anticipating likely effects of anaesthetic and surgical interventions.…”

“…1,8,10 Actual results, however, are limited and mixed. Dore and Somerville 7 reviewed 14 pregnancies among eight patients who underwent Ross repair between 1968 and 1993, all of whom were NYHA class I with normal ventricular function and at worst mild valvular impairment.…”

“…Maternal and neonatal outcomes were excellent apart from one woman who developed dilated cardiomyopathy post partum, and one neonatal death in an infant with spina bifida and hydrocephalus. Campbell et al 10 reported successful management of a parturient with severe pulmonary stenosis and aortic regurgitation secondary to a failed Ross repair, albeit with premature delivery and perioperative dysrhythmia. Most recently, a further 12 pregnancies in five women were examined.…”

“…1,2,7,8 There is limited information on pregnancy-related complications in patients who have previously undergone a Ross repair. 7,[9][10][11] An additional consideration in this case was the presence of a femoro-femoral crossover graft running across the lower abdomen; such a graft has not been previously described in a patient proceeding to caesarean delivery. We therefore report the management of a parturient with a Ross repair and a femoro-femoral crossover graft who presented to our unit for urgent caesarean delivery.…”

Successful use of extracorporeal membrane oxygenation during cesarean section in parturients with symptomatic severe pulmonary stenosis: a case report

“…A 33-year-old primigravid parturient was admitted to the emergency department in the 37 th Several reports describe anesthetic experiences of patients with pulmonary stenosis undergoing vaginal delivery or cesarean section [6][7][8][9]. The use of epidural anesthesia in a parturient with pulmonary stenosis undergoing cesarean section resulted in marked hypotension, junctional arrhythmia, and chest pain.…”