Title : Cesarean Section in patient with Hypertrophy cardiomyopathy done under epidural anaethesiacase report.
Abstract:
Introduction: Hypertrophy cardiomyopathy (HCM) is one of the most common genetic cardiovascular
diseases. It can affect people of any age with equal incidence in men and women.1 There is tremendous
variation in how HCM presents and progresses. Some patients may develop abnormal heart rhythms
(arrythmias) that may put them at increased risk for sudden cardiac death. Young patients coming for
some other surgery may have incidental diagnosis of this condition and may pose considerable challenge
for the Anaesthetists. We report here a case of young female for elective LSCS who had diagnosis of
HCM during antenatal check up.
Case report: A 28 years old women, primigravida presented at 37 weeks of gestation with a diagnosis
of HCM, which was diagnosed in 1st trimester during being investigated for murmur on auscultation.
Throughout the gestation period patient was asymptomatic. Echocardiographic (ECHO) examination
demonstrated HCM features with a peak outflow gradient of 36 mm of Hg, left atrial enlargement and
mild mitral insufficiency. Normal vaginal delivery was planned but on 37 weeks liquor became
inadequate at 36 weeks thus patient had to be taken for elective LSCS. Epidural anaesthesia was given
and case was done successfully.
Discussion : Regional anesthesia is considered to be dangerous in these patients, especially in those with
obstructive HCM, vasodilation associated with sympathetic blockade of the lower extremities may lead
to a critical reduction of preload and afterload.2 Nonetheless, epidural anesthesia alone or combined
with spinal anesthesia has been used safely for vaginal delivery in patients with HCM. Our report
indicates that cesarean section also may be managed safely with epidural anesthesia in patients with
HCM, by using CVP monitoring and maintaining euvolemia or slight hypervolemia.
References:
1. Maron BJ, Gardin JM, Flack JM, Gidding SS, Kurosaki TT, Bild DE: Prevalence of hypertrophic
cardiomyopathy in a general population of young adults. Echocardiographic analysis of 4111
subjects in the CARDIA Study. Circulation 1995; 92:785-9
2. Oakley GD, McGarry K, Limb DG, Oakley CM: Management of pregnancy in patients with
hypertrophic cardiomyopathy. BMJ 1979; 1:1749-50