title: Epidural anesthesia for cesarean section for pregnant women with rheumatic heart disease and mitral stenosis.
abstract: Pregnancy increases stress on the circulation of parturient with mitral stenosis secondary to rheumatic heart disease and increases the risk of peripartum heart failure, especially during delivery. This study investigated the epidural anesthesia management for cesarean section in pregnant women with rheumatic heart disease and mitral stenosis.
  
  
  
  48 parturients with rheumatic heart disease and mitral stenosis that had cesarean section deliveries with epidural anesthesia in the Union Hospital, Fujian Medical University (Fuzhou, China) from Jan 2002 to Dec 2012 were retrospectively analyzed. Heart rate (HR), systolic arterial pressure (SAP), diastolic arterial pressure (DAP), mean arterial pressure (MAP), central venous pressure (CVP), fluid intake volume and fluid output volume (blood loss + urine volume) were analyzed.
  
  
  
  Medication included digitalis drugs for heart failure or potential heart failure, digoxin and furosemide for chronic congestive heart failure and beta blockers for arrhythmia. Frequent premature ventricular contractions were treated with lidocaine and propafenone. Dexamethasone was administered when heart failure occurred during less than 37 weeks gestation. HR, SAP, DAP, MAP and CVP were significantly increased at the time of delivery. The fluid intake volume was more elevated in the NYHA III-IV group of parturients than the NYHA I-II group, while fluid output volume was less. All parturients survived.
  
  
  
  Epidural anesthesia was applied successfully for cesarean sections for parturients with rheumatic heart disease and mitral stenosis.
authors.affiliation: Department of Anesthesia, Union Hospital, Fujian Medical University, Fuzhou, 350001, People's Republic of China.
authors.forename: Wei
authors.initials: W
authors.lastname: Wu
authors.affiliation: Department of Cardiovascular Surgery, Union Hospital, Fujian Medical University, Fuzhou, 350001, People's Republic of China.
authors.forename: Qiang
authors.initials: Q
authors.lastname: Chen
authors.affiliation: Department of Anesthesia, Union Hospital, Fujian Medical University, Fuzhou, 350001, People's Republic of China. wuwei2196@163.com.
authors.forename: Liangcheng
authors.initials: L
authors.lastname: Zhang
authors.affiliation: Department of Anesthesia, Union Hospital, Fujian Medical University, Fuzhou, 350001, People's Republic of China.
authors.forename: Wenhua
authors.initials: W
authors.lastname: Chen
mesh_terms: D000328:Adult; D000767:Anesthesia, Epidural / Q000379:methods*; D000773:Anesthesia, Obstetrical / Q000379:methods*; D000889:Anti-Arrhythmia Agents / Q000008:administration & dosage; D002585:Cesarean Section; D002681:China; D004077:Digoxin / Q000008:administration & dosage; D004232:Diuretics / Q000008:administration & dosage; D005260:Female; D005665:Furosemide / Q000008:administration & dosage; D005865:Gestational Age; D006333:Heart Failure / Q000188:drug therapy / Q000517:prevention & control; D006801:Humans; D008946:Mitral Valve Stenosis / Q000150:complications / Q000503:physiopathology; D011247:Pregnancy; D011249:Pregnancy Complications, Cardiovascular / Q000503:physiopathology; D011256:Pregnancy Outcome; D037841:Pregnant People; D012189:Retrospective Studies; D012214:Rheumatic Heart Disease / Q000150:complications / Q000503:physiopathology; D055815:Young Adult
chemical_list: D000889:Anti-Arrhythmia Agents; D004232:Diuretics; D004077:Digoxin; D005665:Furosemide
keywords: Cesarean section; Epidural anesthesia; Pregnancy; Rheumatic heart disease