Anaesthetic Management for Caesarean Section Surgery in Two Pregnant Women with Severe Pulmonary Hypertension Due to Mitral Valve Stenosis

Abstract

Background: Mitral stenosis is the most important and common cardiac complication seen during pregnancy. Conception is discouraged in cases where pulmonary hypertension develops during the course of mitral stenosis. Successful general and regional anaesthetic interventions have been reported in some cases of severe pulmonary hypertension. Case Reports: We present our experiences with anaesthetic management in two pregnant patients with pulmonary hypertension due to mitral valve stenosis. Conclusion: We preferred to continue spinal anaesthesia because gradually increasing the local anaesthetic dose during the procedure may minimise probable undesirable haemodynamic changes, such as hypotension and tachycardia. Turkish Başlık:Mitral Darlığa Bağlı Şiddetli Pulmoner Hipertansiyonu Olan 2 Gebede Sezaryen İçin Anestezi Yönetimi Anahtar Kelimeler:Mitral darlık, pulmoner hipertansiyon, sezaryen, rejyonel anestezi Arkaplan: Mitral stenoz gebelikte kardiyak komplikasyonlara yol açabilen önemli bir durumdur. Mitral stenoz seyri sırasında pulmoner arteryel (PAH) hipertansiyon gelişen hastalara gebe kalmaları önerilmez. Literatürde ileri derecede PAH'lu gebelere genel ve rejyonel anestezinin başarı ile uygulandığına dair örnekler rapor edilmiştir. Olgu Sunumu: Mitral darlığına bağlı pulmoner hipertansiyonu olan 2 gebe hastamızdaki anestezi yönetimimizi sunmayı amaçladık. Sonuç: Biz bu olgularda istenmeyen hemodinamik değişiklikleri (hipotansiyon ve taşikardi gibi) minimalize edebilmek için lokal anestezi dozunun yavaş yavaş artırılabildiği kontinyu spinal anesteziyi öneriyoruz.

Keywords

• Mitral Stenosis, pulmonary hypertension, caesarean section, regional anaesthesia

Anaesthetic Management for Caesarean Section Surgery in Two Pregnant Women with Severe Pulmonary Hypertension Due to Mitral Valve Stenosis

Öz

References

1. Madden BP. Pulmonary hypertension and pregnancy. Int J Obstet Anesth 2009;18:156-64. [CrossRef]
2. Kocum A, Sener M, Calıskan E, Izmirli H, Tarım E, Kocum T, et al. Epidural anesthesia for cesarean section in a patient with severe mitral stenosis and pulmonary hypertension. J Cardiothorac Vasc Anesth 2010;24:1022-3. [CrossRef]
3. Task Force on the Management of Cardiovascular Diseases During Pregnancy of the European Society of Cardiology. Expert consensus document on management of cardiovascular diseases during pregnancy. Eur Heart J 2003;24:761-81. [CrossRef]
4. Paternoster DM, Pascoli I, Parotto M, Cester M, Nanhornguè K, Merati E, et al. Pulmonary hypertensin during pregnancy:management of two cases. Arch Gynecol Obstet 2010;281:431-4. [CrossRef]
5. Duggans AB, Katz SG. Combined spinal and epidural anesthesia for cesarean section in a parurient with severe primary pulmonary arterial hypertension? Anaesth Intensive Care 2003;31:565-9.
6. Breen TW, Janzen JA. Pulmonary hypertension and cardiomyopaty: anaesthetic management for caesarean section. Can J Anaesth 1991;38:895-9. [CrossRef]
7. Gandhimathi K, Atkinon S, Gibson FM. Pulmonary hypertension complicating twin pregnancy:continuous spinal anaesthesia for caesarean section. Int J Obstet Anesth 2002;11:301-5. [CrossRef]
8. Bedard E, Dimopoulus K, Gatzoulis MA. Has there been any progress made on pregnancy outcomes among women with pulmonary arterial hypertension? Eur Heart J 2009;30:256-65. [CrossRef]

9. Higton AM, Whale C, Musk M, Gabbay E. Pulmonary hypertension in pregnancy:two cases and review of te literature. Int Med J 2009;39:766-70. [CrossRef]
10. Dresner M, Pinder A. Anaesthesia for caesarean section in women with complex cardiac disease: 34 cases using the Braun Spinocath spinal catheter. Int J Obstet Anest 2009;18:131-6. [CrossRef]
11. Palmer CM. Continuous spinal anesthesia and analgesia in obstetrics. Anesth Analg 2010;6:1476-9. [CrossRef] 441 Balkan Med J 2013; 30: 439-41 Çelik et al.
12. Severe Pulmonary Hypertension in Two Pregnant Women