Epidural anesthesia: A safe option for cesarean section in parturient with severe pulmonary hypertension

Abstract

Rheumatic heart disease is the most common cardiac disease complicating pregnancy in developing countries. Heart disease accounts for 15% pregnancy-related mortality. In the presence of maternal heart disease, the circulatory changes of pregnancy may result in exacerbation of the hemodynamic perturbations due to complex cardiac valvular lesions leading to decompensation or death of mother or fetus. Determining the ideal anesthetic technique for cesarean section in the presence of complex cardiac conditions remains a much debated topic. General anesthesia is associated with a further increase in pulmonary pressure in response to laryngoscopy and intubation along with myocardial depression by anesthetic agents. Neuraxial blockade may lead to decrease in systemic vascular resistance and cardiac output. We report the successful anesthetic management of a parturient suffering from rheumatic heart disease with multivalvular lesions resulting in severe pulmonary hypertension under epidural anesthesia with good maternal and neonatal outcome. Successful management requires vigilant perioperative monitoring and thorough knowledge of the hemodynamics of complex cardiac valvular disease.

Keywords: Cesarean section; epidural anesthesia; multiple valvular lesions; rheumatic heart disease; severe pulmonary hypertension.

Figure 1

Electrocardiogram depicting bifid P wave in lead II

Figure 2

Variation of systolic blood pressure, diastolic blood pressure, and mean arterial blood pressure with time

Figure 3

Variation of heart rate, arterial oxygen saturation, and central venous pressure with time