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

Successful Neuraxial Anesthesia for Cesarean Section in a Parturient with Shone's Complex

Abstract Number: 229
Abstract Type: Case Report/Case Series

Robert N Fish M.D.1 ; Alex Joseph M.D., FRCA2

Introduction: Shones complex is a rare set of up to four congenital left sided obstructive cardiac lesions including: parachute mitral valve deformity, a supravalvular ring of the left atrium, subaortic stenosis, and coarctation of the aorta. We describe the first reported successful use of epidural anesthesia for cesarean delivery in a parturient with severe mitral stenosis caused by Shones complex.

Case Presentation: This was a 26 year old gravida 2 parida 1 woman at 36 weeks gestation. At 31 weeks she was diagnosed with severe mitral stenosis (mean gradient 16.5 mmHg), mild pulmonary hypertension (RVSP 41 mmHg), a single papillary muscle, parachute mitral valve, and subaortic stenosis. These findings were consistent with Shones complex. A radial arterial line was placed and a phenylephrine infusion was started prior to dosing of an epidural catheter. Slow titration resulted in a T4 sensory block. Cesarean delivery proceeded uneventfully and both mother and baby did well.

Discussion: The only other reported case of epidural anesthesia for cesarean section in a patient with Shones complex resulted in maternal hypotension, fetal bradycardia, and emergent conversion to a general anesthetic. Our technique differed in that arterial pressure monitoring was established prior to dosing of the epidural and blood pressure was maintained with a phenylephrine infusion.

References:

1. Shone JD, Sellers RD, Anderson RC, et al. The developmental complex of "parachute mitral valve," supravalvular ring of left atrium, subaortic stenosis, and coarctation of the aorta. Am J Cardiol (1963) 11:714-725.

2. Sachse K and Hannallah M. The anesthetic management for cesarean delivery in a patient with Shones syndrome. Anesth Analg (2008) 107:1652-4.

SOAP 2010