title: Anesthetic management for emergency cesarean section and aortic valve replacement in a parturient with severe bicuspid aortic valve stenosis and congestive heart failure.
abstract: Asymptomatic women with mild aortic stenosis (AS) and normal left ventricular functions can successfully carry pregnancy to term and have vaginal deliveries. However, severe AS (valve area <1.0 cm2) can result in rapid clinical deterioration and maternal and fetal mortality. So, these patients require treatment of AS before conception or during pregnancy preferably in the second trimester. In suitable patients percutaneous balloon aortic valvotomy appears to carry lower risk. It can also be used as a palliative procedure allowing deferral of aortic valve replacement until after delivery. The present patient had severe critical AS with congestive heart failure that was refractory to medical therapy and the fetus was viable (>28 wks). So, combined lower segment cesarean section and aortic valve replacement were performed under opioid based general anesthesia technique to reduce the cardiac morbidity and mortality.
authors.affiliation: Department of Anesthesiology, GB Pant Hospital, New Delhi, India. dattvishnu@yahoo.com
authors.forename: Vishnu
authors.initials: V
authors.lastname: Datt
authors.forename: Deepak K
authors.initials: DK
authors.lastname: Tempe
authors.forename: Sanjula
authors.initials: S
authors.lastname: Virmani
authors.forename: Devesh
authors.initials: D
authors.lastname: Datta
authors.forename: Mukesh
authors.initials: M
authors.lastname: Garg
authors.forename: Amit
authors.initials: A
authors.lastname: Banerjee
authors.forename: Akhlesh S
authors.initials: AS
authors.lastname: Tomar
mesh_terms: D000328:Adult; D000773:Anesthesia, Obstetrical; D001021:Aortic Valve / Q000601:surgery*; D001024:Aortic Valve Stenosis / Q000601:surgery*; D002585:Cesarean Section; D004630:Emergencies; D005260:Female; D006333:Heart Failure / Q000601:surgery*; D006801:Humans; D011247:Pregnancy; D011249:Pregnancy Complications, Cardiovascular / Q000601:surgery*