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Anesthetic Management of a Parturient With Noncompaction Cardiomyopathy
Abstract Number: T-09
Abstract Type: Case Report/Case Series
Left ventricular noncompaction cardiomyopathy (LVNC) is a rare cardiomyopathy that results from arrest of the normal compaction process of the myocardium during embryogenesis. Also known as spongy myocardium, it leads to extensive myocardial trabeculations and deep intra-trabecular recesses of the left ventricular cavity. It can be genetically sporadic or familial and can exist as an isolated disorder or occur with other congenital cardiac malformations or neuromuscular disorders.1,2,4,5 Patients most commonly present with symptoms of heart failure and are at increased risk for arrhythmias, thromboembolic events and sudden death.5,6 Only limited evidence in the form of case reports exists in the literature regarding management of LVNC in pregnancy.1-3 We report a favorable outcome in a parturient with LVNC who underwent cesarean delivery with neuraxial anesthesia.
A 28 yo G1P0 was transferred to our institution at 24 weeks in CHF. She denied any past medical history. Echocardiogram revealed an EF of 10-15% with increased trabeculations in the lateral and apical wall of the left ventricle suggestive of LVNC. She was started on carvedilol, furosemide, digoxin and enoxaparin and was discharged home with a wearable automatic defibrillator (LifeVest). The patient was readmitted at 33 wks with progressive SOB and mild hemoptysis. A repeat echo showed severely increased pulmonary artery pressures (PAP) of 60-80 mmHg with an EF of 25-30%. A pulmonary artery catheter was placed and she was transitioned to a heparin drip in preparation for cesarean delivery. At 33 5/7 wks, she was taken to the OR with cardio-pulmonary bypass on standby. A radial A-line was placed, and a low dose combined-spinal epidural with placed with 0.3ml of 0.75% bupivacaine, 15mcg of fentanyl and 0.2mg of preservative free morphine given intrathecally. The epidural catheter was incrementally dosed to achieve a T6 level with a total of 9 ml of 2% lidocaine. She remained hemodynamically stable with no changes in PAP and no need for medical intervention.
1. Krul SP, et al. Eur J Heart Fail. 2011;13:584-94.
2. Stöllberger C, et al. Int J Cardiol 2014; http://dx.doi.org/10.1016/j.ijcard.2013.12.245.
3. Plastiras SC, et al. Exp Clin Cardiol. 2012;17: 136-138.
4. Udeoji DU, et al. Ther Adv Cardiovasc Dis. 2013;7:260-73
5. Dursun M, et al. Eur J Radiol. 2010;74:147-51.
6. Shemisa K, et al. Cardiovasc Diagn Ther. 2013;3:170-5.