title: A Multidisciplinary Approach to Anesthetic Management of a Parturient with Severe Aortic Stenosis.
abstract: In order to optimize anesthetic management and avoid adverse maternal and fetal outcomes, a clear understanding of the changes in cardiovascular physiology that occur during pregnancy is paramount. The effects of normal gestation on the cardiovascular system are particularly significant in a parturient with cardiac valvular pathology. We present a case of a 27-year-old G2P0 at 37 weeks with a past medical history of diabetes, macrosomia, congenital bicuspid aortic valve with severe stenosis (valve area 0.7 cm(2)) who was scheduled for elective C-section. A multidisciplinary discussion involving cardiologists, cardiac surgeons, obstetric surgeons, neonatal intensivists, perfusion staff, anesthesiologists, and nursing staff was held to formulate a plan for the perioperative management of this parturient. Also, contingency plans were formulated and discussed with the care providers, in the event of acute decompensation of the mother and baby and possible need for emergency aortic valvuloplasty and/or aortic valve replacement.
authors.affiliation: Department of Anesthesiology, Maimonides Medical Center, 4802 10th Avenue, Brooklyn, NY 11219, USA.
authors.forename: Kalpana
authors.initials: K
authors.lastname: Tyagaraj
authors.affiliation: Department of Anesthesiology, Maimonides Medical Center, 4802 10th Avenue, Brooklyn, NY 11219, USA.
authors.forename: David A
authors.initials: DA
authors.lastname: Gutman
authors.affiliation: Department of Anesthesiology, Maimonides Medical Center, 4802 10th Avenue, Brooklyn, NY 11219, USA.
authors.forename: Lynn
authors.initials: L
authors.lastname: Belliveau
authors.affiliation: Department of Cardiology, Maimonides Medical Center, 4802 10th Avenue, Brooklyn, NY 11219, USA.
authors.forename: Adnan
authors.initials: A
authors.lastname: Sadiq
authors.affiliation: Department of Neonatology, Maimonides Medical Center, 4802 10th Avenue, Brooklyn, NY 11219, USA.
authors.forename: Alok
authors.identifier: 0000-0002-2079-4069
authors.initials: A
authors.lastname: Bhutada
authors.affiliation: Department of Anesthesiology, Maimonides Medical Center, 4802 10th Avenue, Brooklyn, NY 11219, USA.
authors.forename: Dennis E
authors.initials: DE
authors.lastname: Feierman