title: [Elective cesarean section with epidural anesthesia in a pregnant woman with obstructive hypertrophic myocardiopathy].
abstract: Hypertrophic obstructive myocardiopathy (HOM) is characterised by left ventricular hypertrophy, which causes dynamic obstruction at the exit of the chamber and diastolic dysfunction of the myocardium. The use of epidural anesthesia in patients with HOM is controversial due to the hemodynamic repercussions of reduced preloading and postloading that occur. A 28-year-old woman with HOM was scheduled for cesarean delivery at 36.5 weeks because of delayed intrauterine growth. Satisfactory epidural anesthesia was provided with 0.5% bupivacaine with prior invasive hemodynamic monitoring. Analgesic and anesthetic management of a full-term parturient with HOM is a major challenge for the anesthesiologist. Although elective cesarean under general anesthesia is traditionally suggested for such patients, vaginal delivery with epidural analgesia is currently also being used. However, experience in using epidural anesthesia for cesarean delivery is scarce. For our patient, epidural anesthesia with appropriate hemodynamic monitoring allowed surgery to take place without complications. We therefore believe that the technique might be useful for such patients.
authors.affiliation: Servicio de Anestesiología, Hospital Universitario Joan XXIII, Tarragona. jru@tinet.fut.es
authors.forename: J
authors.initials: J
authors.lastname: Recasens Urbez
authors.forename: S
authors.initials: S
authors.lastname: Boada Pie
authors.forename: E
authors.initials: E
authors.lastname: Solsona Della
authors.forename: J
authors.initials: J
authors.lastname: Saludes Serra
authors.forename: J M
authors.initials: JM
authors.lastname: Bueno Izquierdo
authors.forename: M
authors.initials: M
authors.lastname: Rull Bartomeu
mesh_terms: D000328:Adult; D000767:Anesthesia, Epidural; D000773:Anesthesia, Obstetrical; D002312:Cardiomyopathy, Hypertrophic; D002585:Cesarean Section; D017558:Elective Surgical Procedures; D005260:Female; D006801:Humans; D011247:Pregnancy; D011249:Pregnancy Complications, Cardiovascular