Anesthesia in pregnancy with heart disease

Abstract

Management of pregnant women with heart disease remains challenging due to the advancement of innovations in cardiac surgery and correction of complex cardiac anomalies, and more recently, with the successful performance of heart transplants, cardiac diseases are not only likely to coexist with pregnancy, but will also increase in frequency over the years to come. In developing countries with a higher prevalence of rheumatic fever, cardiac disease may complicate as many as 5.9% of pregnancies with a high incidence of maternal death. Since many of these deaths occur during or immediately following parturition, heart disease is of special importance to the anesthesiologist. This importance arises from the fact that drugs used for preventing or relieving pain during labor and delivery exert a major influence – for better or for worse – on the prognosis of the mother and newborn. Properly administered anesthesia and analgesia can contribute to the reduction of maternal and neonatal mortality and morbidity.

Case Report Onventricular Septal Defect (VSD) with Pulmonary Hypertention (Eisenmenger Syndrome) with LSCS

“…In the present case, emergency LSCS was done for the management of Eisenmenger syndrome during pregnancy. After LSCS patient condition was good and the baby was admitted to NICU because of low birth weight and patient breathing difficulty managed by oxygen therapy [11].…”

Pregnancy Management in a Patient With Congenital Heart Disease and Severe Right Ventricle to Pulmonary Artery Conduit Stenosis

“…Overall anesthetic considerations include control of hypervolemia, acidosis, and minimal pulmonary vascular resistance/systemic vascular resistance alterations. 18 Benefits of general anesthesia include the avoidance of profound sympathetic block, commonly seen in spinal and epidural techniques, and the ability to concomitantly use transesophageal echocardiography. 19 Regional (epidural and spinal) anesthesia preserves the mother's baseline ventilation and perfusion state.…”

Low dose hyperbaric bupivacaine 5 mg combined with 50 mcg fentanyl for cesarean section in maternal heart disease

“…Factors considered to determine the anesthetic technique include parturient's hemodynamic status, type of heart disease, previous drug use, and elective / emergency surgery. 4 GA is more widely used in patients that fall in a higher New York Heart Association (NYHA) class and have history of previous heart surgery. 5 GA is still an option in cases where regional anesthesia cannot be performed.…”