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///2018 Abstract Details
2018 Abstract Details2019-08-02T15:57:01-05:00

Anesthetic Management of Laboring Parturient with a History of Coarctation of the Aorta

Abstract Number: T3C-9
Abstract Type: Case Report/Case Series

Brittany Bond MD1 ; Barbara Orlando MD2; Justine Viola MD3

Coarctation of the Aorta accounts for approximately 6-8% of congenital heart disease. An increasing number of women with previously corrected coarctation are now becoming pregnant. Restenosis of the coarctation site occurs in up to 35% and aneurysm formation in 16%. Lifelong follow up is necessary with investigations including MRI, ambulatory blood pressure measurements, and echocardiograms. We describe a case of neuraxial anesthesia for scheduled cesarean section in a parturient with a coarctation of the aorta status-post surgical correction and subsequent dilation of her aorta.

A 36-year-old G2P0 in her second trimester presented for antenatal anesthesia consultation. She had a history of coarctation of the aorta with surgical resection and end-to-end anastomosis of the aorta at 2 weeks of age. In 1994, she underwent balloon dilation of her descending aorta due to recurrence of the stricture. Upon presentation to our clinic, the patient was asymptomatic, exercising daily, mentioning only slight shortness of breath during her pregnancy. She was on no medications besides prenatal vitamins. Her echo revealed mild mitral prolapse and mild to moderate stenosis of the mitral valve with one papillary muscle, suggestive of a parachute mitral valve, a bicuspid aortic valve with mild stenosis, and tapering of the descending aorta with post stenotic dilatation, suggesting significant obstruction. Her Cardiologist felt that the higher peak velocities seen on her echo were normal in pregnancy. A plan was initially made for early labor analgesia, but later changed to scheduled cesarean delivery, per the patient’s preference. On the day of delivery at 36 weeks and 4 days gestation, the patient was hemodynamically stable with a reassuring fetal heart tracing. A radial arterial line was placed prior to the induction of anesthesia. An epidural anesthetic was administered with a gradual loading dose of lidocaine 2% without epinephrine to avoid increases in heart rate. Sensory level achieved was T8 bilaterally. The patient remained hemodynamically stable throughout the cesarean section and delivered a healthy baby girl. The mother was monitored closely after delivery and remained stable throughout her hospital course.

The three main goals of anesthesia in a parturient with history of Coarctation are to maintain adequate intravascular volume, prevent hemodynamic changes, and provide adequate perioperative pain relief. Because a titrated dose of local anesthetic can be given, epidural anesthesia conveys better hemodynamic stability as compared to general anesthesia or a single shot spinal. It overcomes the disadvantages of general anesthesia, such as increases in heart rate and blood pressure during intubation, which may lead to aortic rupture, dissection, of left ventricular failure or the disadvantages of a single shot spinal, such as tachycardia and hypotension.

1) E Sener (2014) Case Rep in Med 12: 115–120. 2) S Venning (2003) J R Soc Med 96: 234–236

SOAP 2018