Key result
Graded epidural anaesthesia enables successful caesarean delivery in a dilated cardiomyopathy patient with LVEF 20%.
Case Report (n=1)
Graded epidural anaesthesia is a feasible and successful technique for caesarean section in parturients with severe left ventricular dysfunction due to dilated cardiomyopathy.
May warrant consideration of graded epidural in similar high-risk parturients; leaves open confirmation in prospective studies.
Dilated cardiomyopathy (DCM) is a primary disorder of heart muscle characterised by left ventricular (LV) or biventricular dilatation and impaired ventricular contractility. During pregnancy, women with DCM have a higher incidence of cardiac events than the non-pregnant patient. When DCM is associated with severe LV dysfunction, anaesthetic management is particularly challenging, because severe LV dysfunction is a predictor of sudden cardiac death and poor quality of life. The goals of anaesthetic management in DCM consist of maintaining normovolaemia, and avoiding myocardial depression and drug overdose during induction (as circulation time is slow). It also includes preventing increases in ventricular afterload and sudden hypotension when regional anaesthesia is a choice. This case report describes the successful anaesthetic management of a parturient with DCM and a severely low LV ejection fraction of 20%, wherein the child was delivered via caesarean section using a graded epidural anaesthesia technique.
No takes yet. Share an insight, caveat, or question.
Ige et al. (2017) conducted a case report in Dilated cardiomyopathy with severe left ventricular dysfunction (n=1). Graded epidural anaesthesia was evaluated on Successful anaesthetic management and delivery. Graded epidural anaesthesia was successfully used for caesarean section in a parturient with dilated cardiomyopathy and a severely low left ventricular ejection fraction of 20%.
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: