Key result
A 23-year-old parturient with severe functional mitral stenosis from an undersized mechanical valve successfully underwent a cesarean delivery using a dural puncture epidural technique.
Case Report (n=1)
A multidisciplinary approach utilizing dural puncture epidural anesthesia and ECMO preparation allows for safe cesarean delivery in parturients with severe functional mitral stenosis from congenital mitral dysplasia.
Dural puncture epidural may enable cesarean delivery in severe functional mitral stenosis; hypothesis-generating and leaves open need for prospective validation.
We present the anesthetic management of a 23-year-old gravida 2 para 0-0-1-0 with a history of mitral valve replacement secondary to congenital mitral dysplasia. The hemodynamic changes of pregnancy had resulted in severe functional mitral stenosis of her mechanical valve, which was significantly undersized for her current body surface area. Her complex cardiac history required our multidisciplinary team to focus on peripartum anticoagulation management, extracorporeal membrane oxygenation (ECMO) preparation under a dural puncture epidural (DPE) technique, and managing the hemodynamic changes that are critical for a congenital heart disease parturient.
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Johnson et al. (2020) conducted a case report in Congenital mitral dysplasia and severe functional mitral stenosis in pregnancy (n=1). Dural puncture epidural (DPE) and multidisciplinary management for cesarean delivery was evaluated. A 23-year-old parturient with severe functional mitral stenosis from an undersized mechanical valve successfully underwent a cesarean delivery using a dural puncture epidural technique.
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