///2010 Abstract Details
2010 Abstract Details2019-08-03T15:49:10-05:00

Ceserean Section in a 17yo with Coarctation of the Suprarenal Aorta from Takayasu Aortitis: A Case Report

Abstract Number: 188
Abstract Type: Case Report/Case Series

Brandon Thompson MD1 ; Uma Munnur MD2

TAKAYASU ARTERITIS

Takayasu arteritis is a chronic inflammatory disorder of large to medium vessels. The etiology is from autoimmune mechanisms that are antibody mediated. The disease primarily affects women in 80-90% of cases and onset of disease usually presents at age 10-40years.

The pathology of Takayasu arteritis is an inflammatory process of the thoracic or abdominal aorta or its branches that results in thickening of the vessel wall. As a result of the vessel thickening, there can be narrowing of the lumen with a clinical presentation of coarctation. In addition to vessel wall thickening, post-stenotic aneurysmal dilation can occur as a result of the destruction of the elastic intima and muscular media from inflammatory cells.

CASE REPORT

A 17yo primagravid female of 37 weeks gestation, presented for a primary cesarean section. The past medical history was significant for a diagnosis of hypertension at age 11 during which time she described claudication symptoms of her lower extremities. She was placed on blood pressure medications at that time and followed by her physician in Honduras.

She was first admitted at 26 6/7 weeks gestation with imaging records demonstrating a suprarenal 8cm segment of abdominal aortic narrowing with a lumen of 5mm. Umbilical and common femoral arteries were visualized and showed adequate flow. MRA of the brain were negative. An Echocardiogram was showed normal ventricular size and function with ejection fraction of 60%.

After a multidisciplinary meeting was held it was decided that an elective cesarean would be scheduled under epidural regional anesthesia. However, prior to the scheduled date the patient went into labor and the case was done emergently.

In preop holding area, 2 large bore IVs and a right radial arterial line were placed. She was then moved to the OR bed. A left arm central venous catheter was placed in the antecubital vein. The right femoral arterial line was placed under ultrasound guidance. The pressure gradient at that time was noted to be approximately 50mmHg between the radial and femoral artery mean pressures.

An epidural catheter was placed in a sitting position and then bolused with 15 cc of Bupivicaine 0.5% with Fentanyl 4mcg/cc in slow increments of 3cc every 5 minutes and then 9cc of Lidocaine 2% was given. The patient had a T6 level and the team proceeded with surgery. After delivery of the baby and placenta, the blood pressure was maintained with boluses of IV fluid with a low dose infusion of phenylephrine due to uterine atony.

The patient was hemodynamically stable throughout with a total of 3500ml Lactated ringers and 1000ml of Hetastarch given. The phenylephrine infusion was stopped after uterine tone and hemostasis was achieved. Blood loss was estimated to be 1200ml. At the conclusion of the procedure, the epidural catheter was bolused with Butorphanol 1mg and Morphine 4mg, epidural catheter removed and the patient was transfered to the ICU for further care

SOAP 2010