Complete heart block complicating intracranial aneurysm surgery in a pregnant patient.

摘要

Intracranial aneurysm clipping in a pregnant patient is challenging, more so in the presence of a coexisting complete heart block (CHB) with the potential to compromise hemodynamic stability. Adequate control of blood pressure (BP) is vital during aneurysm surgery and may not always be guaranteed by temporary pacing. A primigravida at 28 weeks of gestation was diagnosed with a left internal carotid artery aneurysm with subarachnoid hemorrhage, World Federation of Neurosurgical Societies (WFNS) Grade-2, necessitating urgent aneurysm clipping. Relevant preoperative checkup included no apparent history of syncopal episodes, a BP of 90/60 mm of Hg, a heart rate of 41 beats/min, a CHB on ECG and no evidence of underlying cardiac disease on echocardiography. The patient was paced with a temporary transvenous pacemaker at a rate of 80 beats/ min; her post-pacing BP was 118/72 mm of Hg. During surgery, the patient's BP fell abruptly to 82/56 mm of Hg which was normalized by resetting the pacemaker rate at 90 beats/min. Repeated pacemaker adjustments became necessary in the postoperative period to maintain stable post-clipping systolic BP in the range of 140-160 mmHg; a permanent pacemaker was then inserted in her.