Advertisement

Anesthesia for Pregnant Patient with Cardiac Disease

  • Demet Coskun
  • Ahmet Mahli
Chapter

Abstract

Management of pregnant women with heart disease has always been challenging. However, owing to recent novelties in cardiac surgery and correction of cardiac anomalies as well as the successful performance of heart transplants, it is possible that cardiac diseases will coexist with pregnancy and the frequency will increase in future. Using proper approach with respect to the suitable use of analgesics and anesthetics, in addition to both the pathophysiology and pharmacological therapy regarding the parturient, how these interact with anesthetic care should be considered meticulously. Although the conditions of cardiac pathology such as congenital or acquired, functional or structural, cyanotic or noncyanotic, and endocardial, myocardial, or pericardial defects may not have shown symptoms during non-pregnancy state, they become evident during mid-to-late pregnancy as an outcome of developing physiologic hemodynamic stresses. When the pregnant patient is encountered by the anesthetist, different structural lesions might be uncorrected, fully corrected, or partially corrected. Most of the time, since a single approach to the management of cardiac lesions is not present, a concurrence on the optimal anesthetic technique does not exist.

Keywords

Anesthesia Management Pregnancy Cardiac disease Surgery 

References

  1. 1.
    Kuczkowski KM. Anesthesia for the parturient with cardiovascular disease. South Afr J Anaesth Analg. 2014;9:19–25.Google Scholar
  2. 2.
    Luthra A, Bajaj R, Jafra A, Jangra K, Arya VK. Anesthesia in pregnancy with heart disease. Saudi J Anaesth. 2017;11:454–71.CrossRefGoogle Scholar
  3. 3.
    Gianopoulos JG. Cardiac disease in pregnancy. Med Clin North Am. 1989;73:639–51.CrossRefGoogle Scholar
  4. 4.
    Johnson MD, Saltzman DH. Cardiac disease. In: Dutta S, editor. Anesthetic and obstetric management of high-risk pregnancy. St Louis: Mosby; 1996. p. 200–45.Google Scholar
  5. 5.
    The Criteria Committee of the New York Heart Association. Nomenclature and criteria for diagnosis of diseases of the heart and great vessels. 9th ed. Boston: Little, Brown; 1994. p. 253–6.Google Scholar
  6. 6.
    Kuczkowski KM. Labor analgesia for the parturient with cardiac disease: what does an obstetrician need to know? Acta Obstet Gynecol Scand. 2004;83:223–33.CrossRefGoogle Scholar
  7. 7.
    Ramin SM, Maberry MC, Gilstrap LC 3rd. Congenital heart disease. Clin Obstet Gynecol. 1989;32:41–7.CrossRefGoogle Scholar
  8. 8.
    Van de Velde M. Nonobstetric surgery during pregnancy. In: Chestnut DH, Wong CA, Tsen LC, Ngan Kee WD, Beilin Y, Mhyre J, editors. Chestnut’s obstetric anesthesia principles and practice. 5th ed. Philadelphia: Saunders; 2014. p. 358–79.Google Scholar
  9. 9.
    Ní Mhuireachtaigh R, O’Gorman DA. Anesthesia in pregnant patients for nonobstetric surgery. J Clin Anesth. 2006;18:60–6.CrossRefGoogle Scholar
  10. 10.
    Mazze RI, Kallen B. Reproductive outcome after anesthesia and operations during pregnancy: a registry study of 5405 cases. Am J Obstet Gynecol. 1989;161:1178.CrossRefGoogle Scholar
  11. 11.
    Ngan Kee WD, Lau TK, Khaw KS, Lee BB. Comparison of metaraminol and ephedrine infusions for maintaining arterial pressure during spinal anesthesia for elective cesarean section. Anesthesiology. 2001;95:307–13.CrossRefGoogle Scholar
  12. 12.
    Lee A, Ngan Kee WD, Gin T. A quantitative, systematic review of randomized controlled trials of ephedrine versus phenylephrine for the management of hypotension during spinal anesthesia for cesarean delivery. Anesth Analg. 2002;94:920–6.CrossRefGoogle Scholar
  13. 13.
    Steinbrook RA, Bhavani-Shankar K. Hemodynamics during laparoscopic surgery in pregnancy. Anesth Analg. 2001;93:1570–1.CrossRefGoogle Scholar
  14. 14.
    Parry AJ, Westaby S. Cardiopulmonary bypass during pregnancy. Ann Thorac Surg. 1996;61:1865–9.CrossRefGoogle Scholar
  15. 15.
    Dajani AS, Bisno AL, Chung KJ, Durack DT, Freed M, Gerber MA, et al. Prevention of bacterial endocarditis. Recommendations by the American Heart Association. JAMA. 1990;264:2919–22.CrossRefGoogle Scholar
  16. 16.
    Moore RA. Anesthesia for pediatric congenital heart patient for non-cardiac surgery. Anesthesiol Rev. 1981;8:23.Google Scholar
  17. 17.
    Oxorn D, Edelist G, Smith MS. An introduction to transoesophageal echocardiography: II. Clinical applications. Can J Anaesth. 1996;43:278–94.CrossRefGoogle Scholar
  18. 18.
    Wong V, Cheng CH, Chan KC. Fetal and neonatal outcome of exposure to anticoagulants during pregnancy. Am J Med Genet. 1993;45:17–21.CrossRefGoogle Scholar
  19. 19.
    Barbour LA, Pickard J. Controversies in thromboembolic disease during pregnancy: a critical review. Obstet Gynecol. 1995;86:621–33.PubMedGoogle Scholar
  20. 20.
    Sugrue D, Blake S, MacDonald D. Pregnancy complicated by maternal heart disease at the National Maternity Hospital, Dublin, Ireland: 1969 to 1978. Am J Obstet Gynecol. 1981;139:1–6.CrossRefGoogle Scholar
  21. 21.
    Clark SL. Monitoring and anaesthetic management of parturients with mitral stenosis. Can J Anaesth. 1987;34:654.CrossRefGoogle Scholar
  22. 22.
    Hemmings GT, Whalley DG, O’Connor PJ, Benjamin A, Dunn C. Invasive monitoring and anaesthetic management of a parturient with mitral stenosis. Can J Anaesth. 1987;34:182–5.CrossRefGoogle Scholar
  23. 23.
    WDN K, Shen J, Chiu AT, Lok I, Khaw KS. Combined spinal-epidural analgesia in the management of labouring parturients with mitral stenosis. Anaesth Intensive Care. 1999;27:523–6.Google Scholar
  24. 24.
    Ziskind S, Etchin A, Frenkel Y, Mashiach S, Lusky A, Goor DA, et al. Epidural anesthesia with the trendelenburg position for cesarean section with or without a cardiac surgical procedure in patients with severe mitral stenosis: a hemodynamic study. J Cardiothorac Anesth. 1990;3:354–9.CrossRefGoogle Scholar
  25. 25.
    Batson MA, Longmire S, Csontos E. Alfentanil for urgent caesarean section in a patient with severe mitral stenosis and pulmonary hypertension. Can J Anaesth. 1990;37:685–8.CrossRefGoogle Scholar
  26. 26.
    Rayburn WF, Fontana ME. Mitral valve prolapse and pregnancy. Am J Obstet Gynecol. 1981;41:9–11.CrossRefGoogle Scholar
  27. 27.
    Shaikh SI, Lakshmi RR, Hegade G. Perioperative anesthetic management for cesarean section in patients with cardiac disease. Anesth Pain Intensive Care. 2014;18:377–85.Google Scholar
  28. 28.
    Easterling TR, Chadwick HS, Otto CM, Benedetti TJ. Aortic stenosis in pregnancy. Obstet Gynecol. 1988;72:113–8.PubMedGoogle Scholar
  29. 29.
    Colclough GW, Ackerman WE 3rd, Walmsley PM, Hessel EA. Epidural anesthesia for a parturient with critical aortic stenosis. J Clin Anesth. 1995;7:264–5.CrossRefGoogle Scholar
  30. 30.
    Redfern N, Bower S, Bullock RE, Hull CJ. Alfentanil for caesarean section complicated by severe aortic stenosis. A case report. Br J Anaesth. 1988;60:477.CrossRefGoogle Scholar
  31. 31.
    Forster R, Joyce T. Spinal opioids and the treatment of the obstetric patient with cardiac disease. Clin Perinatol. 1989;16:955–74.CrossRefGoogle Scholar
  32. 32.
    Walker E, Malins AF. Anesthetic management of aortic coarctation in pregnancy. Int J Obstet Anesth. 2004;13:266–70.CrossRefGoogle Scholar
  33. 33.
    Maitra G, Sengupta S, Rudra A, Debnath S. Pregnancy and non-valvular heart disease – anesthetic considerations. Ann Card Anaesth. 2010;13:102–9.CrossRefGoogle Scholar
  34. 34.
    Vidovich MI. Cardiovascular disease. In: Chestnut DH, Wong CA, Tsen LC, Ngan Kee WD, Beilin Y, Mhyre J, editors. Chestnut’s obstetric anesthesia principles and practice. 5th ed. Philadelphia: Saunders; 2014. p. 960–1002.Google Scholar
  35. 35.
    Mangano DT. Anesthesia for the pregnant cardiac patient. In: Shnider SM, Levinson G, editors. Anesthesia for obstetrics. 3rd ed. Philadelphia: Williams & Wilkins; 1993. p. 485.Google Scholar
  36. 36.
    Brickner ME. Cardiovascular management in pregnancy: congenital heart disease. Circulation. 2014;130:273–82.CrossRefGoogle Scholar
  37. 37.
    Patton DE, Lee W, Cotton DB, Miller J, Carpenter RJ Jr, Huhta J, et al. Cyanotic maternal heart disease in pregnancy. Obstet Gynecol Surv. 1990;45:594–600.CrossRefGoogle Scholar
  38. 38.
    Aglio LS, Johnson MD. Anesthetic management of myocardial infarction in a parturient. Br J Anaesth. 1990;65:258–61.CrossRefGoogle Scholar
  39. 39.
    Smith RL, Young SJ, Greer IA. The parturient with coronary heart disease. Int J Obstet Anesth. 2008;17:46–52.CrossRefGoogle Scholar
  40. 40.
    Mahli A, Izdes S, Coskun D. Cardiac operations during pregnancy: review of factors influencing fetal outcome. Ann Thorac Surg. 2000;69:1622–6.CrossRefGoogle Scholar
  41. 41.
    Chambers CE, Clark SL. Cardiac surgery during pregnancy. Clin Obstet Gynecol. 1994;37:316–23.CrossRefGoogle Scholar
  42. 42.
    Rossouw GJ, Knott-Craig CJ, Barnard PM, Macgregor LA, Van Zyl WP. Intracardiac operation in seven pregnant women. Ann Thorac Surg. 1993;55:1172–4.CrossRefGoogle Scholar
  43. 43.
    Monnery L, Nanson J, Charlton G. Primary pulmonary hypertension in pregnancy; a role for novel vasodilators. Br J Anaesth. 2001;87:295–8.CrossRefGoogle Scholar
  44. 44.
    Weiss BM, Zemp L, Seifert B, Hess OM. Outcome of pulmonary vascular disease in pregnancy: a systematic overview from 1978 through 1996. J Am Coll Cardiol. 1998;31:1650–7.CrossRefGoogle Scholar
  45. 45.
    Palmer CM, DiNardo JA, Hays RL, van Maren GA. Use of transesophageal echocardiography for delivery of a parturient with severe pulmonary hypertension. Int J Obstet Anesth. 2002;11:48–51.CrossRefGoogle Scholar
  46. 46.
    Decoene C, Bourzoufi K, Moreau D, Narducci F, Crepin F, Krivosic-Horber R. Use of inhaled nitric oxide for emergency cesarean section in a woman with unexpected primary pulmonary hypertension. Can J Anaesth. 2001;48:584–7.CrossRefGoogle Scholar
  47. 47.
    Lam GK, Stafford RE, Thorp J, Moise KJ Jr, Cairns BA. Inhaled nitric oxide for primary pulmonary hypertension in pregnancy. Obstet Gynecol. 2001;98:895–8.PubMedGoogle Scholar
  48. 48.
    Khan MJ, Bhatt SB, Kryc JJ. Anesthetic considerations for parturient with primary pulmonary hypertension: review of the literature and clinical presentation. Int J Obstet Anesth. 1996;5:36–42.CrossRefGoogle Scholar
  49. 49.
    Toyama H, Wagatsuma T, Ejima Y, Matsubara M, Kurosawa S. Cesarean section and primary pulmonary hypertension: the role of intravenous dexmedetomidine. Int J Obstet Anesth. 2009;18:262–7.CrossRefGoogle Scholar
  50. 50.
    Coskun D, Mahli A, Korkmaz S, Demir FS, Inan GK, Erer D, et al. Anaesthesia for caesarean section in the presence of multivalvular heart disease and severe pulmonary hypertension: a case report. Cases J. 2009;22(2):9383.CrossRefGoogle Scholar
  51. 51.
    Minnich ME, Quirk JG, Clark RB. Epidural anesthesia for vaginal delivery in a patient with idiopathic hypertrophic subaortic stenosis. Anesthesiology. 1987;67:590–2.CrossRefGoogle Scholar
  52. 52.
    Ho KW, Kee WDN, Poon MCM. Combined spinal and epidural anesthesia in a parturient with idiopathic hypertrophic subaortic stenosis. Anesthesiology. 1997;87:168–9.CrossRefGoogle Scholar
  53. 53.
    Tessler MJ, Hudson R, Naugler-Colville M, Biehl DR. Pulmonary oedema in two parturients with hypertrophic obstructive cardiomyopathy (HOCM). Can J Anaesth. 1990;37:469–73.CrossRefGoogle Scholar
  54. 54.
    Gei AF, Hankins GD. Cardiac disease and pregnancy. Obstet Gynecol Clin N Am. 2001;28:465–512.CrossRefGoogle Scholar
  55. 55.
    Yacoub A, Martel MJ. Pregnancy in a patient with primary dilated cardiomyopathy. Obstet Gynecol. 2002;99:928.PubMedGoogle Scholar
  56. 56.
    Kluger MT, Bersten AD. Multi-organ failure in peripartum cardiomyopathy. Anaesth Intensive Care. 1991;19:450–3.PubMedGoogle Scholar
  57. 57.
    Hibbard JU, Lindheimer M, Lang RM. A modified definition for peripartum cardiomyopathy and prognosis based on echocardiography. Obstet Gynecol. 1999;94:311–6.PubMedGoogle Scholar
  58. 58.
    Beards SC, Freebairn RC, Lipman J. Successful use of continuous veno-venous haemofiltration to treat profound fluid retention in severe peripartum cardiomyopathy. Anaesthesia. 1993;48:1065–7.CrossRefGoogle Scholar
  59. 59.
    Löwenstein BR, Vain NW, Perrone SV, Wright DR, Boullón FJ, Favaloro RG. Successful pregnancy and vaginal delivery after heart transplantation. Am J Obstet Gynecol. 1988;158(3 Pt 1):589–90.CrossRefGoogle Scholar
  60. 60.
    Camann WR, Goldman GA, Johnson MD, Moore J, Greene M. Cesarean delivery in a patient with a transplanted heart. Anesthesiology. 1989;71:618–20.CrossRefGoogle Scholar

Copyright information

© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Gazi University School of Medicine, Department of Anesthesiology and ReanimationAnkaraTurkey
  2. 2.Yuksek Ihtisas University School of Medicine, Department of Anesthesiology and ReanimationAnkaraTurkey

Personalised recommendations