title: Chest ultrasonography in emergency Cesarean delivery in multi-valvular heart disease with pulmonary edema during spinal anesthesia.
abstract: Valvular heart disease in a parturient presenting for Cesarean section is challenging. A 25 year old primigravida parturient with severe mitral stenosis, mild mitral regurgitation, mild aortic regurgitation, and mild pulmonary arterial hypertension required Cesarean delivery after developing pulmonary edema. Low-dose spinal with hyperbaric bupivacine 0.5% 1.8 mL plus 25 μg of fentanyl was used for anesthesia. Chest ultrasonography (US) and transthoracic echocardiography (TTE) were used for monitoring purposes. Spinal-induced preload reduction improved the pulmonary edema, as evidenced by chest US. Chest US and TTE helped in fluid management.
authors.affiliation: Department of Anesthesia & Critical Care (Trauma Centre), JPNA Trauma Centre, AIIMS, New Delhi, India 110029. Electronic address: dr.sukhensamanta@gmail.com.
authors.forename: Sukhen
authors.initials: S
authors.lastname: Samanta
authors.affiliation: Department of Critical Care Medicine, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Luckow, India 226014.
authors.forename: Sujay
authors.initials: S
authors.lastname: Samanta
authors.affiliation: Department of Critical Care Medicine, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Luckow, India 226014.
authors.forename: Tanmoy
authors.initials: T
authors.lastname: Ghatak
authors.affiliation: Department of Anesthesia and Intensive Care, Post Graduate Institute of Medical Education & Research, Chandigarh, India 160012.
authors.forename: V K
authors.initials: VK
authors.lastname: Grover
mesh_terms: D000328:Adult; D000773:Anesthesia, Obstetrical / Q000379:methods; D000775:Anesthesia, Spinal / Q000379:methods*; D002045:Bupivacaine / Q000008:administration & dosage; D002585:Cesarean Section / Q000379:methods*; D004452:Echocardiography / Q000379:methods; D005260:Female; D005283:Fentanyl / Q000008:administration & dosage; D006349:Heart Valve Diseases / Q000150:complications* / Q000000981:diagnostic imaging / Q000503:physiopathology; D006801:Humans; D006976:Hypertension, Pulmonary / Q000150:complications / Q000000981:diagnostic imaging; D011247:Pregnancy; D011249:Pregnancy Complications, Cardiovascular / Q000000981:diagnostic imaging / Q000503:physiopathology; D011654:Pulmonary Edema / Q000150:complications* / Q000000981:diagnostic imaging
chemical_list: D005283:Fentanyl; D002045:Bupivacaine
keywords: Cesarean section; Chest ultrasound; Spinal anaesthesia; Valvular heart disease