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Anesthetic management for emergency cesarean section and aortic valve replacement in a parturient with severe bicuspid aortic valve stenosis and congestive heart failure


1 Department of Anesthesiology, GB Pant Hospital, New Delhi, India
2 Department of CTVS, GB Pant Hospital, New Delhi, India

Correspondence Address:
Vishnu Datt
Department of Anesthesiology and Intensive Care, Room No. 619, 6th Floor, Academic Block, GB Pant Hospital, New Delhi-110002
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0971-9784.58838

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Year : 2010  |  Volume : 13  |  Issue : 1  |  Page : 64-68

 

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Asymptomatic women with mild aortic stenosis (AS) and normal left ventricular functions can successfully carry pregnancy to term and have vaginal deliveries. However, severe AS (valve area <1.0cm 2 ) can result in rapid clinical deterioration and maternal and fetal mortality. So, these patients require treatment of AS before conception or during pregnancy preferably in the second trimester. In suitable patients percutaneous balloon aortic valvutomy appears to carry lower risk. It can also be used as a palliative procedure allowing deferral of aortic valve replacement until after delivery. The present patient had severe critical AS with congestive heart failure that was refractory to medical therapy and the fetus was viable (>28wks). So, combined lower segment cesarean section and aortic valve replacement were performed under opioid based general anesthesia technique to reduce the cardiac morbidity and mortality.






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1 Department of Anesthesiology, GB Pant Hospital, New Delhi, India
2 Department of CTVS, GB Pant Hospital, New Delhi, India

Correspondence Address:
Vishnu Datt
Department of Anesthesiology and Intensive Care, Room No. 619, 6th Floor, Academic Block, GB Pant Hospital, New Delhi-110002
India
Login to access the Email id

Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0971-9784.58838

Rights and Permissions

Asymptomatic women with mild aortic stenosis (AS) and normal left ventricular functions can successfully carry pregnancy to term and have vaginal deliveries. However, severe AS (valve area <1.0cm 2 ) can result in rapid clinical deterioration and maternal and fetal mortality. So, these patients require treatment of AS before conception or during pregnancy preferably in the second trimester. In suitable patients percutaneous balloon aortic valvutomy appears to carry lower risk. It can also be used as a palliative procedure allowing deferral of aortic valve replacement until after delivery. The present patient had severe critical AS with congestive heart failure that was refractory to medical therapy and the fetus was viable (>28wks). So, combined lower segment cesarean section and aortic valve replacement were performed under opioid based general anesthesia technique to reduce the cardiac morbidity and mortality.






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