Cesarean Delivery in a Parturient With "Repaired" Congenital Mitral Dysplasia and Severe Functional Mitral Stenosis: A Case Report

• Type of Material: Article
• Authors: Erica Johnson, Emory University; James Dolak, Emory University
• Language: English
• Date: 2020-04-01
• Publisher: Lippincott Williams & Wilkins
• Publication Version: Final Published Version
• Copyright Statement: © 2020 The Author(s). Published by Wolters Kluwer Health, Inc. on behalf of the International Anesthesia Research Society.
• License: Creative Commons Attribution-NonCommercial-NoDerivs 4.0 International
• Final Published Version (URL): http://dx.doi.org/10.1213/XAA.0000000000001203
• Title of Journal or Parent Work: A&A Practice
• Volume: 14
• Issue: 6
• Start Page: e01203
• End Page: e01203
• Grant/Funding Information: None.
• Keywords: Stroke Volume; Humans; Ventricular Function, Left; Cesarean Section; Pregnancy; Mitral Valve Stenosis; Heparin, Low-Molecular-Weight; Female; Young Adult
• Research Categories: Health Sciences, Medicine and Surgery; Health Sciences, Obstetrics and Gynecology; Health Sciences, Health Care Management

Abstract

We present the anesthetic management of a 23-year-old gravida 2 para 0-0-1-0 with a history of mitral valve replacement secondary to congenital mitral dysplasia. The hemodynamic changes of pregnancy had resulted in severe functional mitral stenosis of her mechanical valve, which was significantly undersized for her current body surface area. Her complex cardiac history required our multidisciplinary team to focus on peripartum anticoagulation management, extracorporeal membrane oxygenation (ECMO) preparation under a dural puncture epidural (DPE) technique, and managing the hemodynamic changes that are critical for a congenital heart disease parturient.