title: Anesthetic management of a repeat cesarean section in a parturient with severe peripartum cardiomyopathy requiring ECMO in a previous pregnancy: a case report.
abstract: The number of pregnant women with cardiac disease is increasing with improvements in technology. In addition, more people are part of the national health insurance plan. However, there are few reports concerning the best method for anesthesia and mode of delivery in these high-risk patients. We report a 29-year-old woman scheduled for a planned caesarean section, who had a history of severe peripartum cardiomyopathy requiring extracorporeal membrane oxygenation in a previous pregnancy. The patient had regular prenatal care in our obstetric clinic. At 29 weeks' gestation, she developed severe dyspnea. A chest radiograph revealed bilateral pulmonary edema and 2-dimensional echocardiography showed a global hypokinesis and severe valve regurgitation with left ventricular ejection fraction of 41.2%. She had an emergency caesarean section and a cardiovascular surgeon was consulted to stand-by. Anesthesia was induced by ketamine 25 mg, midazolam 2.5 mg and rocuronium 50 mg for rapid intubation. The patient tolerated the procedure well and was extubated on postoperative day 1. She was discharged one week after surgery. Postoperatively, the patient was followed in the obstetric and cardiovascular surgery outpatient departments and at 5 months after surgery she was in good condition without any complaints.
authors.affiliation: Department of Anesthesiology, Chang Gung Memorial Hospital at Linkou, Chang Gung University College of Medicine, Taoyuan, Taiwan.
authors.forename: Hsiu-Pin
authors.initials: HP
authors.lastname: Chen
authors.forename: Wei-Che
authors.initials: WC
authors.lastname: Sung
authors.forename: Yu-Ling
authors.initials: YL
authors.lastname: Hui
authors.forename: Chung-Kun
authors.initials: CK
authors.lastname: Hui
mesh_terms: D000328:Adult; D000768:Anesthesia, General; D009202:Cardiomyopathies / Q000150:complications* / Q000175:diagnosis; D017604:Cesarean Section, Repeat; D004417:Dyspnea / Q000150:complications; D015199:Extracorporeal Membrane Oxygenation; D005260:Female; D006801:Humans; D011247:Pregnancy; D011249:Pregnancy Complications, Cardiovascular; D011654:Pulmonary Edema / Q000150:complications* / Q000175:diagnosis