Perioperative challenges in a case of rheumatic mitral valve disease with pulmonary hypertension and recent left ventricular failure for elective caesarean section

Abstract

RHD remains the most common cause of maternal cardiac complications in pregnancy. It is of special concern to anaesthesiologist especially in immediate post-partum period with potential risk of severe cardiopulmonary complications requiring stringent hemodynamic monitoring. Our case was a 38 year female (Gravida-2,parity-1,Living -1) with history of previous LSCS, now 35 weeks pregnant, posted for elective LSCS in view of RHD with severe MS (valve area -1.5 cm2) severe PAH (PASP-66mm Hg), Severe AR and moderate MR with gestational hypertension. Under cardiology standby plan of anaesthesia was low dose combined spinal epidural following Right IJV cannulation for hemodynamic monitoring with patient requiring minimal dose of inotropic support during surgery and 2 days of ICU stay for intensive monitoring. Perioperative anaesthesia management was accomplished with good maternal and neonatal outcome.