Abstract

Introduction

Cardiac disease in pregnancy poses a unique challenge to the obstetrician and anaesthesiologist. Rheumatic mitral stenosis forms 88% of heart diseases complicating pregnancy in tertiary referral centres in India. The mortality and morbidity are considerably reduced by better perinatal care, where anaesthesiologist plays a major role¹. Thecase report of a patient with severe mitral stenosis (MS) and pulmonary artery hypertension (PAH) for elective caesarean section is being presented.

Case Report

A 25year lady (gravida 2, para1, living 1) with MS and PAH (underwent balloon mitral valvotomy six years ago) at 36 weeks of gestation was planned for elective LSCS. She had a previous normal vaginal delivery four years ago which was uneventful. However during the present pregnancyat 33 weeks of gestation, she had dyspnoea at rest and was found to have severe residual stenosis of mitral valve. She was admitted at 34 weeks of gestation with worsening dyspnoea and bilateral pedal oedema suggestive of heart failure. She was managed conservatively with diuretics, beta blockers and cardiac glycosides in the intensive care unit. On examination she was dyspnoeic, heart rate – 68/ min, blood pressure-100/60 mm hg and Spo2 of 98% on room air. Crepitations was present in left apical region. Hematology and biochemistry investigations were within normal limits. Electrocardiogram showed normal sinus rhythm. Transthoracic echocardiogram revealed severe mitral stenosis, tricuspid regurgitation and  severe pulmonary artery hypertension (mitral valve orifice – 0.8 cm2, pulmonary artery systolic pressure -64 mmhg), mitral Valve pressure gradient – 41 mmhg,ejection fraction- 60%). She was on Tab Furosemide 40 mg BD, Tab Digoxin 0.125 mg OD, Tab Metoprolol 12.5 mg BD and Tab Penicillin G 400 mg BD. She was electively posted for caesarean section at 36 weeks of gestation and assessed under ASA III.