///2010 Abstract Details
2010 Abstract Details2018-05-01T17:52:49+00:00

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.


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