title: Cesarean section in a patient with non-compaction cardiomyopathy managed with ECMO.
abstract: Isolated ventricular non-compaction is a rare cardiomyopathy associated with left heart failure, severe arrhythmias and thromboembolism. We report about our interdisciplinary strategy in a patient with severe isolated ventricular non-compaction cardiomyopathy scheduled for caesarean section in general anaesthesia. Monitoring included placement of an arterial line, a central venous catheter and a pulmonary artery catheter with pacing option. Small introducer gates were placed in the femoral artery and vein to facilitate quick percutaneous institution of extracorporeal life support via extracorporeal membrane oxygenation in case of acute cardiac failure refractory to medical treatment. Inotropic pharmacological therapy with 3 µg/kg/min dobutamine and 0.25 mg/kg/min milrinone was started before surgery. Induction of general anesthesia and rapid sequence intubation was performed with an analgesic dose of 0.5 mg/kg S ketamine, 0.25 mg/kg etomidate and 5 mg rocoronium followed by 1.5 mg/kg succinylcholine. This regimen provided completely stable hemodynamics in this critical period until delivery of the child and continuation of anaesthesia with continuous infusion of propofol and remifentanyl. The current strategies, particularly the preparation for femoro-femoral extracorporeal membrane oxygenation, may be considered in similar cases with a high risk of acute cardiac decompensation which may be refractory to medical treatment. Anaesthesiologist involved in performing caesarean section in women with complex cardiac disease, should encompass extracorporeal membrane oxygenation standby in management of the perioperative period.
authors.affiliation: Institute of Anaesthesiology, Heart and Diabetes Centre North Rhine-Westphalia, Bad Oeynhausen, Ruhr-University Bochum, Germany.
authors.forename: A A
authors.initials: AA
authors.lastname: Koster
authors.affiliation: Department of Anesthesia and Intensive Care, San Raffaele Scientific Institute, Milan, Italy.
authors.forename: F
authors.initials: F
authors.lastname: Pappalardo
authors.affiliation: Department of Anesthesia and Intensive Care, San Raffaele Scientific Institute, Milan, Italy.
authors.forename: S
authors.initials: S
authors.lastname: Silvetti
authors.affiliation: Institute of Anaesthesiology, Heart and Diabetes Centre North Rhine-Westphalia, Bad Oeynhausen, Ruhr-University Bochum, Germany.
authors.forename: U
authors.initials: U
authors.lastname: Schirmer
authors.affiliation: Institute of Anaesthesiology, Heart and Diabetes Centre North Rhine-Westphalia, Bad Oeynhausen, Ruhr-University Bochum, Germany.
authors.forename: J U
authors.initials: JU
authors.lastname: Lueth
authors.affiliation: Department of Anaesthesiology, Hospital of Bad Oeynhausen, Germany.
authors.forename: R
authors.initials: R
authors.lastname: Dummler
authors.affiliation: Department of Anaesthesiology, Hospital of Bad Oeynhausen, Germany.
authors.forename: M
authors.initials: M
authors.lastname: Emmerich
authors.affiliation: Department of Gynaecology and Obstetrics, Hospital of Bad Oeynhausen, Germany.
authors.forename: M
authors.initials: M
authors.lastname: Schmitt
authors.affiliation: Clinic for Congenital Heart Disease, Heart and Diabetes Centre North Rhine-Westphalia, Bad Oeynhausen, Ruhr-University Bochum, Germany.
authors.forename: G
authors.initials: G
authors.lastname: Kirchne
authors.affiliation: Clinic for Congenital Heart Disease, Heart and Diabetes Centre North Rhine-Westphalia, Bad Oeynhausen, Ruhr-University Bochum, Germany.
authors.forename: D
authors.initials: D
authors.lastname: Kececioglu
authors.affiliation: Department of Surgery of Congenital Heart Disease, Heart and Diabetes Centre North Rhine-Westphalia, Ruhr-University Bochum, Bad Oeynhausen, Germany.
authors.forename: E
authors.initials: E
authors.lastname: Sandica
keywords: ECMO; heart failure; setio