Clinical Implication of Inducible Left Ventricular Outflow Tract Obstruction in Patients Undergoing Liver Transplant Evaluation

Anesthetic management of a parturient with Shone’s syndrome -a case report with review of literature-

“…In the six case reports described in our review: i) Mitral valve-Parachute MV was seen two women (33.3%) with both of them having moderate MV stenosis [14,16]. Dysplastic MV leaflets were observed in one case (16.6%) and mild MV stenosis seen in two (33.3%) [11,13,15].…”

“…Mean age of women in the literature review was 24 years, mean body mass index was 26.3kg/m 2 and five of the six women (83.3%) of all women were primparous. All the published case reports in our review had partial or incomplete form of SS (100%) with two of the six women (33.3%) having some form of surgical correction in childhood [14,16].…”

“…We found six published case reports of SS in pregnancy since the year 2000 [11][12][13][14][15][16]. Their demographics, initial presentation to the delivery unit, echocardiogram findings, maternal, and neonatal outcomes along with their anesthetic management are presented in table 1.…”

“…Dyspnoea on exertion, orthopnoea, palpitations and pulmonary oedema were the presenting symptoms in four case reports (66.7%) [12,13,15,16]. Beta blockers and diuretics were commonly utilised in these cases.…”

“…Women can also present with systemic hypertension where Co-A features in SS prominently. In three of the case reports (50%), the reported BP on presentation was greater than 140/90mmHg [12,13,16]. These patients may be mistakenly diagnosed with pre-eclampsia but absence of proteinuria, a normal urinary: protein creatinine ratio and use of biomarkers such as ratio of sFlt-1 (soluble FMS-like tyrosine kinase-1; an anti-angiogenic factor) / PlGF (placental growth factor; an angiogenic factor) might provide clues to the obstetric team in ruling out pre-eclampsia [17].…”