Mitral stenosis and pregnancy: Current concepts in anaesthetic practice

Abstract

The incidence of rheumatic mitral stenosis is grossly reduced in India. Still, among heart disease complicating pregnancy, rheumatic mitral stenosis occupies a greater segment. The unique physiological changes in pregnancy and the pathological impact of mitral stenosis over pregnancy and labour are discussed in detail. A multidisciplinary approach in the diagnosis and management reduces the mortality and morbidity during peripartum. The labour analgesia technique and the evidence-based regional and general anaesthesia techniques are discussed at length in this article.

Isolated cor triatriatum sinistrum and pregnancy: case report and review of the literature

“…20 Furthermore, immediately after delivery in a healthy woman, uterine autotransfusion acutely and additionally increases intravascular volume, resulting in up to an 80% increase in cardiac output. 16,[20][21][22] These changes in hemodynamic variables may pose a substantial risk for parturients with CTS and especially those with restrictive flow across the intra-atrial membrane. Therefore, CTS patients who were symptomatic before pregnancy, 1,23 or even asymptomatic in previous pregnancies, 12 may be at risk for cardiac decompensation during and after delivery.…”

“…16 An animation showing cardiac decompensation associated with pregnancy, labour, and the postpartum period in an isolated CTS heart is shown in the Video (available as Electronic Supplementary Material). Cor triatriatum sinistrum increases the likelihood to become symptomatic after 20 weeks of gestation and more likely during delivery and in the postpartum period; 22,32 therefore, early identification of all asymptomatic patients with CTS (i.e., evaluate all ''innocent'' heart murmurs) is extremely important. It remains a matter of judgment (on the part of a cardiologist) whether CTS has the potential to decompensate in pregnancy.…”

Anesthesia Management of a Patient with Sickle Hemoglobinopathy and Mitral Stenosis for Emergency Lower (Uterine) Segment Cesarean Section

“…Therefore, individualizing the anesthetic management according to parturient's condition and experience of existing treatment options is the key to success in these patients. 8 Regional anesthesia has proved to be a safe technique for cesarean section in cardiac patient with mild-tomoderate MS. Epidural anesthesia causes segmental blockade, gradual onset, and less hemodynamic variations. However, neuraxial blockade in anticoagulated patients has a high risk of epidural hematoma.…”

Anaesthetic Challenge in Undiagnosed Mitral Valvular Disease in Emergency Lower Segment Caesarean Section in a Secondary Level Hospital – A Case Report

“…The patient was preloaded with 500ml Hartmann's solution and initial dose of third generation cephalosporin was given iv. Subarachnoid block was activated at L3-4 Karim ME 1 …”

“…Rheumatic mitral stenosis forms 88% of the heart diseases complicating pregnancy 1 . The likelihood of an adverse outcome is related to the type and severity of maternal valvular disease and the resulting abnormalities of functional capacity, left ventricular function, and pulmonary pressure.…”