Why the study?
The physiological changes of pregnancy may exacerbate sub-valvular aortic stenosis, posing significant challenges for anaesthesia and surgery.
Highlights the successful anaesthetic management of a pregnant patient with sub-valvular aortic stenosis undergoing emergency cesarean section by avoiding tachycardia, decreased afterload/preload, and increased contractility.
Supports individualized anaesthetic strategies in pregnancy with subvalvular aortic stenosis; hypothesis-generating and should not yet change practice.
Sub-valvular aortic stenosis (SAS) occurs due to a fibrous membrane or a muscular narrowing causing left ventricular outflow tract obstruction. The physiological changes of pregnancy may exacerbate the cardiac condition posing significant challenges for anaesthesia and surgery. A 34 years primigravida, with 32 weeks gestation, a known case of sub-valvular aortic stenosis presented in the emergency room in view of leaking/bleeding per-vagina. Risk factors such as tachycardia, decrease in afterload, preload and increased left ventricle contractility lead to exacerbation of the obstruction and should be avoided. We report a successful anaesthetic management of her lower segment cesarean section while balancing the physiological changes of pregnancy superimposed by pathology of the disease.
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Chhabra et al. (2022) studied this question.
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