Combined mitral and aortic stenosis in parturient: Anesthesia management for labor and delivery

Kela, Manish; Buddhi, Madhvi

doi:10.4103/0970-9185.168169

Cited by 4 publications

(3 citation statements)

References 12 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Our choice for general anesthesia was based on several factors. Regional anesthesia, especially epidural technique, may prove beneficial for labor in low doses as it decreases catecholamine release and hemodynamic stress 9 ; however a critical problem with these patients is the inability to maintain cardiac output with a decrease in SVR and the dosage required to achieve surgical anesthesia, even when employing a graded epidural technique may have been enough to cause significant vasodilation 2 . Moreover, coexisting mitral stenosis further decreases cardiac output leading to hypotension-induced myocardial ischemia, and hence epidural-induced vasodilation could have been catastrophic in this patient 2 .…”

Section: Discussionmentioning

confidence: 99%

Cesarean section of a patient with combined severe mitral and aortic stenosis: a case report

Sheikh

Samad

Mistry

2023

Annals of Medicine &Amp; Surgery

View full text Add to dashboard Cite

Introduction and Importance: Cardiovascular diseases during pregnancy are rare but account for complications that pose risks to the mother as well as the child. In patients with fixed cardiac output due to stenotic valvular lesion(s), the physiological changes during pregnancy carry high risk of morbidity and mortality. Case Presentation: Our patient was diagnosed with severe mitral and aortic stenosis at her first antenatal visit at 24 weeks of gestation. She was also diagnosed with intrauterine growth restriction and was therefore planned to be operated on at a gestational age of 34 weeks. After careful selection of monitoring and anesthetic regime, the patient was managed without any intraoperative or postoperative complications. Clinical Discussion: This case reports how the anesthetists, obstetricians, and cardiac surgeons devised a well-designed plan to operate on a patient with a relatively rare disease manifestation. Our patient had coexisting severe stenotic lesions of both mitral and aortic valves and posed a clinical dilemma regarding the choice of anesthesia and perioperative management. Regardless of the anesthetic technique, goals for a patient with the combined valvular disease include maintenance of adequate preload, systemic vascular resistance, cardiac contractility, sinus rhythm and avoidance of tachycardia, bradycardia, aortocaval compression, and anesthetic or surgery-induced hemodynamic changes. Conclusion: The course of management would give clinicians an idea of how to manage a patient with combined stenotic valvular lesions for cesarean section, ensuring a smooth course and a safe postoperative period.

show abstract

Section: Discussionmentioning

confidence: 99%

Cesarean section of a patient with combined severe mitral and aortic stenosis: a case report

Sheikh

Samad

Mistry

2023

Annals of Medicine &Amp; Surgery

View full text Add to dashboard Cite

show abstract

“…5 A scheduled Cesarian section is recommended for women with severe valvular lesions or symptoms. 38,61 Cardiac anesthesia specialists may be required for high-risk cases, and this decision should ideally be made by the cardio-obstetrics team in advance of the anticipated delivery day to allow for proper staffing and planning. Endocarditis prophylaxis is generally not necessary.…”

Section: Delivery Planning Labor and Deliverymentioning

confidence: 99%

Valvular Heart Disease in Pregnancy

Shapiro,

Alshawabkeh

2024

Methodist DeBakey Cardiovascular Journal

View full text Add to dashboard Cite

Valvular heart disease is a common cause of peripartum cardiovascular morbidity and mortality. The hemodynamic changes of pregnancy and their impact on preexisting valvular lesions are described in this paper. Tools for calculation of maternal and fetal risk during pregnancy are also discussed. The pathophysiology and management of valvular lesions, both obstructive and regurgitant, are then described, followed by discussion of mechanical and bioprosthetic valve complications during pregnancy.

show abstract

“…In women with aortic valvulopathy in which pregnancy is contraindicated or undesired, the woman should be offered contraception in the form of a copper intrauterine device, progesterone intrauterine system or a progesterone implantable contraception before conception. [22][23][24][25][26] These measures aim to prevent an unplanned pregnancy which is likely to cause hemodynamic instability in the mother. It also protects a potential Fetus from the teratogenic effects of maternal cardiac medications and reduces the risk of development of congenital heart defects.…”

Section: Preconception Counselingmentioning

confidence: 99%

Management of aortic valve disease during pregnancy: A review

et al. 2019

View full text Add to dashboard Cite

Cardiovascular disease represents a significant portion of pregnancy‐related complications and is associated with high rates of morbidity and mortality in this cohort. Cardiac valvulopathy, and aortic valve pathologies, in particular, pose a significant challenge to women who are pregnant and to the health care professionals who look after them. Depending on the type and severity of aortic valve pathology, pregnancy may exacerbate or accelerate the progression of valvulopathy sequelae because of the hemodynamic changes that occur from conception, throughout gestation, up to Labor and postpartum. Management of such patients ranges from basic conservative measures such as bed‐rest, extending to high‐risk emergency open heart surgery. This nonstructured review aims to highlight the current evidence available relating to the management of aortic valve disease in pregnancy, with a key focus on cases which requires intervention beyond that of medical therapy. In conclusion, the management of aortic valvulopathy in pregnancy is a challenging field with only a small amount of clinical experience and retrospective study supporting evidence‐based decisions in this field. A greater understanding of the most recent advances is recommended to support decision making in this specialist field of clinical medicine.

show abstract

Combined mitral and aortic stenosis in parturient: Anesthesia management for labor and delivery

Cited by 4 publications

References 12 publications

Cesarean section of a patient with combined severe mitral and aortic stenosis: a case report

Cesarean section of a patient with combined severe mitral and aortic stenosis: a case report

Valvular Heart Disease in Pregnancy

Management of aortic valve disease during pregnancy: A review

Contact Info

Product

Resources

About