Hypertrophic cardiomyopathy and caesarean section: intraoperative use of transthoracic echocardiography

A pregnant woman with severe hypertrophic cardiomyopathy was monitored with transthoracic echocardiography to guide management of fluids and vasopressors during elective caesarean section. After insertion of intravenous, arterial and central venous cannulae, a transthoracic echocardiogram was perfor...

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Bibliographic Details
Published in:International journal of obstetric anesthesia 2006-10, Vol.15 (4), p.311-316
Main Authors: Ferguson, E.A., Paech, M.J., Veltman, M.G.
Format: Article
Language:English
Subjects:
Adult
Caesarean section
Cardiomyopathy, Hypertrophic - diagnostic imaging
Cardiomyopathy, Hypertrophic - physiopathology
Cesarean Section
Combined spinal-epidural anaesthesia
Female
Humans
Hypertrophic cardiomyopathy
Intraoperative Care
Pregnancy
Pregnancy Complications, Cardiovascular - diagnostic imaging
Pregnancy Complications, Cardiovascular - physiopathology
Pregnancy, High-Risk
Transthoracic echocardiography
Ultrasonography
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Description
Summary:A pregnant woman with severe hypertrophic cardiomyopathy was monitored with transthoracic echocardiography to guide management of fluids and vasopressors during elective caesarean section. After insertion of intravenous, arterial and central venous cannulae, a transthoracic echocardiogram was performed noting left ventricular cavity size and contractility, systolic anterior motion of the mitral valve and left ventricular outflow tract obstruction. Following combined spinal-epidural anaesthesia, serial examinations were made intraoperatively. Short-lived haemodynamic instability ensued just before the incision and with administration of oxytocin. Her postoperative course was complicated by post-partum haemorrhage requiring radiological intervention but she ultimately recovered fully. Maintaining preload to avoid worsening of left ventricular outflow tract obstruction is essential in these patients. A transthoracic echocardiogram is easily performed, of low risk and provides more useful information than a pulmonary artery catheter.
ISSN:0959-289X
1532-3374
DOI:10.1016/j.ijoa.2005.08.008