[Perioperative treatment of a pregnant woman with recent cerebral infarction secondary to noncompaction cardiomyopathy].
Recent-onset noncompaction of the myocardium is a rare but serious entity with uncertain prognosis. Cerebral infarction is among the forms of presentation, and pregnancy and hypercoagulability increase risk. We report the case of a pregnant woman brought to the emergency department with ischemic cerebral infarction. Investigation demonstrated the cause to be cardiac embolism, and noncompaction of the myocardium was diagnosed. She was stabilized and a few days later underwent elective cesarean section under general anesthesia. Surgery and postoperative recovery were uneventful, and she was transferred for rehabilitation. Myocardial injury and progression to cerebrovascular accident must be prevented in such cases; the patient must be stabilized and antiplatelet and/or anticoagulant therapy initiated before surgery. Hemodynamic stability must be maintained throughout the perioperative period and neonatal depression avoided after delivery. Various approaches are available to be adapted to the patient's situation.
Fernández Sánchez
L J
LJ
Servicio de Anestesiología y Reanimación, Hospital Universitario La Paz, Madrid. lucas.doc@hotmail.com
Pérez González
R
R
Guasch Arévalo
E
E
Martín Reyes
R
R
Gilsanz Rodríguez
F
F
D000319:Adrenergic beta-Antagonists / Q000008:administration & dosage; D000732:Androstanols / Q000008:administration & dosage; D000768:Anesthesia, General / Q000379:methods*; D000769:Anesthesia, Inhalation; D000771:Anesthesia, Intravenous; D000773:Anesthesia, Obstetrical / Q000379:methods*; D002545:Brain Ischemia / Q000209:etiology*; D009202:Cardiomyopathies / Q000150:complications* / Q000151:congenital / Q000473:pathology; D002585:Cesarean Section; D005260:Female; D005283:Fentanyl / Q000008:administration & dosage; D006352:Heart Ventricles / Q000002:abnormalities*; D006429:Hemiplegia / Q000209:etiology / Q000534:rehabilitation; D006801:Humans; D007231:Infant, Newborn; D020244:Infarction, Middle Cerebral Artery / Q000209:etiology* / Q000534:rehabilitation; D020766:Intracranial Embolism / Q000209:etiology*; D008738:Methyl Ethers / Q000008:administration & dosage; D003473:Neuromuscular Nondepolarizing Agents / Q000008:administration & dosage; D011247:Pregnancy; D011249:Pregnancy Complications, Cardiovascular / Q000473:pathology*; D011250:Pregnancy Complications, Hematologic / Q000209:etiology* / Q000534:rehabilitation; D011412:Propanolamines / Q000008:administration & dosage; D015742:Propofol / Q000008:administration & dosage; D000077123:Rocuronium; D000077149:Sevoflurane; D019851:Thrombophilia / Q000209:etiology
D000319:Adrenergic beta-Antagonists; D000732:Androstanols; D008738:Methyl Ethers; D003473:Neuromuscular Nondepolarizing Agents; D011412:Propanolamines; D000077149:Sevoflurane; C036604:esmolol; D005283:Fentanyl; D000077123:Rocuronium; D015742:Propofol