Epidural anesthesia for cesarean section in a patient with severe mitral stenosis and pulmonary hypertension.

摘要

Mitral stenosis (MS) is the most prevalent clinically significant cardiac disease in pregnant women.1 It is considered severe when the mitral valve area is 1 cm2 or less, and maternal mortality rate may reach 15% if MS is accompanied by symptomatic pulmonary hypertension.Although it previously has been described that delivery may be safely managed via graded epidural anesthesia for mild-to-moderate MS cases, there are very few reports of women with severe MS undergoing caesarean section via epidural anesthesia.3-4 The authors present a parturient with severe MS and secondary severe pulmonary hypertension who underwent a cesarean section. A 33-year-old, 164-cm, 78-kg woman was admitted at the 32nd week of gestation with breathlessness and hemoptysis. She was not on any cardiovascular medication during her gestation. Echo-cardiography revealed severe MS (mitral valve area = 0.67 cm2, mean gradient = 17 mmHg), severe tricuspid regurgitation, and pulmonary hypertension (pulmonary artery systolic pressure [PASP] = 100 mmHg). The left ventricular systolic function was normal. Obstetric ultrasonography revealed intrauterine growth retardation. The patient's symptoms improved with diuretic (fu-rosemide, 80 mg/d intravenously) and beta-blocker (metoprolol, 25 mg/d orally) treatment, and she underwent cesarean delivery on the 7th day of her admission.