title: Caesarean delivery in a parturient with a femoro-femoral crossover graft and congenital aortic stenosis repaired by the Ross procedure.
abstract: We report a case of a patient with congenital aortic stenosis previously repaired using the Ross procedure, who presented to our unit for urgent caesarean delivery. Management was complicated by moderate residual cardiac disease and the presence of a suprapubic femoro-femoral crossover graft. Following application of five-lead electrocardiogram and invasive blood pressure monitoring, anaesthesia was induced via combined spinal-epidural with epidural volume extension. A high transverse surgical approach avoided the course of the vascular graft, while further precautions included the immediate availability of vascular surgeons and cell salvage. Our anaesthetic technique was tailored to minimise disruption to cardiovascular function, and in particular to limit regurgitant flow across the pulmonary valve. This case highlights the value of early identification of high-risk parturients and multidisciplinary involvement at delivery. Risk stratification in the patient with grown-up congenital heart disease is based upon timely evaluation of the underlying congenital pathology, surgical history and subsequent functional status.
authors.affiliation: Department of Anaesthesia, Singleton Hospital, Sketty Road, Swansea SA2 8QA, United Kingdom. RichardsonPB@cardiff.ac.uk
authors.forename: P
authors.initials: P
authors.lastname: Richardson
authors.forename: S
authors.initials: S
authors.lastname: Whittaker
authors.forename: U
authors.initials: U
authors.lastname: Rajesh
authors.forename: M
authors.initials: M
authors.lastname: Bonduelle
authors.forename: J
authors.initials: J
authors.lastname: Morgan
authors.forename: M
authors.initials: M
authors.lastname: Garry
authors.forename: C
authors.initials: C
authors.lastname: Weston
authors.forename: C
authors.initials: C
authors.lastname: Ferguson
authors.forename: L
authors.initials: L
authors.lastname: Fligelstone
mesh_terms: D000773:Anesthesia, Obstetrical; D001021:Aortic Valve / Q000601:surgery; D001024:Aortic Valve Stenosis / Q000150:complications* / Q000000981:diagnostic imaging / Q000601:surgery*; D001794:Blood Pressure / Q000502:physiology; D006348:Cardiac Surgical Procedures; D002585:Cesarean Section; D005260:Female; D005263:Femoral Artery / Q000637:transplantation*; D006801:Humans; D007231:Infant, Newborn; D010120:Oxytocics; D010121:Oxytocin; D010149:Postoperative Pain / Q000188:drug therapy; D011247:Pregnancy; D011664:Pulmonary Valve / Q000601:surgery / Q000637:transplantation; D018570:Risk Assessment; D014182:Transplantation, Autologous; D014463:Ultrasonography; D055815:Young Adult
chemical_list: D010120:Oxytocics; D010121:Oxytocin