Severe Primary Pulmonary Hypertension in Pregnancy: Case Report

Abstract

ardiac disease is one of the most important causes of maternal morbidity and mortality. Physiological changes that occur during pregnancy such as increased blood volume, decreased systemic vascular resistance, fluctuating cardiac output and predisposition to coagulation causes increases in the cardiac work load. The incidence of cardiac disease in pregnancy is reported as being 0,2-4% in the developed world.1,2 A dvances in the diagnosis and treatment of congenital and rheumatic cardiac diseases have resulted in more women being able to conceive. The physiological changes in the cardiovascular system during pregnancy, parturition and the postnatal period pose a health risk for patients.3,4 The incidence of cardiovascular system pathology also increases with the use of anesthesia.Pulmonary hypertension (PH) seen during pregnancy may be idiopathic or secondary to cardiovascular diseases and has a reported mortality rate of 30-56%. [5][6][7] The aim of this case report was to discuss the preoperative anesthesia method in a pregnant woman with PH and a high cardiac risk.Turkiye Klinikleri J Case Rep 2015;23 (2) 113 Severe Primary Pulmonary Hypertension in Pregnancy: Case Report A AB BS ST TR RA AC CT T In this case report, the management of a 35-week pregnant patient with primary pulmonary hypertension who had a cesarean section operation under regional anesthesia is discussed in the light of literature. In the preoperative examination, the patient suffered from severe dyspnea. She was discovered to have tricuspid insufficiency (4°) and her systolic pulmonary arterial pressure (PAP) was measured at 110 mmHg. The patient was successfully managed with combined spinal epidural anesthesia and was then referred to the cardiology intensive care unit.K Ke ey y W Wo or rd ds s: : Idiopathic pulmonary hypertension; pregnancy; anesthesia, spinal Ö ÖZ ZE ET T Bu olgu sunumunda 35 haftalık primer pulmoner hipertansiyonlu gebe bir hastada rejyonel anestezi altında sezaryen cerrahisi yönetimi literatür eşliğinde tartışılmıştır. Hastanın preoperatif değerlendirilmesinde ileri derecede dispneik olduğu görüldü. Ayrıca 4° triküspit yetersizliği mevcuttu ve sistolik pulmoner arter basıncı (PAP) 110 mmHg idi. Başarılı bir kombine spinal epidural anestezi yönetimi ile hasta sorunsuz bir şekilde kardiyoloji yoğun bakım ünitesine transfer edildi.A An na ah ht ta ar r K Ke el li im me el le er r: : İdiyopatik pulmoner hipertansiyon; gebelik; anestezi, spinal T Tu ur rk ki iy ye e K Kl li in ni ik kl le er ri i J J C Ca as se e R Re ep p 2 20 01 15 5; ;2 23 3( (2 2) ): :1 11 13 3--6 6