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CASE REPORT

Perioperative Anesthesia Management for Pregnant Mother with Multivalvular Heart Disease and Moderate Pulmonary Hypertension Who Underwent Caesarean Section, in Resource Limiting Area 2022: A Case Report

, & ORCID Icon
Pages 311-317 | Received 26 Jan 2023, Accepted 18 May 2023, Published online: 22 May 2023
 

Abstract

Introduction

As measured by a right heart catheterization, pulmonary hypertension is an increase in mean pulmonary arterial pressure of more than 25 mmHg at rest or more than 30 mmHg during exercise. Some of the cardiac heart conditions that may develop during pregnancy include severe mitral regurgitation and mild tricuspid regurgitation. Prior to delivery, pregnant patients with pulmonary hypertension and significant multivalvular heart disease need to undergo careful preoperative, multidisciplinary assessment, and anaesthetic planning to maximize cardiac function during the peripartum period and make informed decisions about the delivery mood and anaesthetic technique.

Case Presentation

A 30-year-old Para two Gravid three pregnant mother presented with chronic rheumatic heart disease, severe mitral regurgitation, moderate pulmonary hypertension, severe left atrial dilatation, mild aortic regurgitation, and mild tricuspid regurgitation scheduled for elective cesarean section. She had one previous cesarean section four years ago with an indication of fetal macrosomia. Her cardiac condition, however, was moderate mitral regurgitation, mild left atrial dilatation, mild pulmonary hypertension, and no tricuspid or aortic regurgitation. She had continuous follow-ups after diagnosis until now but has not taken any medication.

Conclusion

Anaesthesia management in a patient with severe mitral regurgitation, moderate pulmonary hypertension, severe left atrial dilatation, mild aortic regurgitation, and mild tricuspid regurgitation was challenging in resource limited area. Even if spontaneous delivery is recommended for the patients with cardiac findings, a cesarean delivery will need in the area where limited access to support it. Goal-directed perioperative management with multidisciplinary involvement helps the patient to have a good outcome.

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Ethics Approval and Consent to Participate

For both procedural and anaesthetic purposes, as well as to take part in this study, we had the required patient and family consent. The patient gave her permission for the clinical information and images to be included in the paper for publication. Throughout along, confidentiality was upheld, and appropriate efforts were made to protect her privacy.

Publication Consent

Written informed consent has been provided by the patient for publication of the case details.

Disclosure

The authors report no conflicts of interest in this work.