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1 - Structural heart disease in pregnant women

from Section 1 - Cardiovascular and respiratory disorders

Published online by Cambridge University Press:  19 October 2009

By
Brendan Carvalho  and
Ethan Jackson
Edited by
David R. Gambling ,
M. Joanne Douglas  and
Robert S. F. McKay
Brendan Carvalho
Affiliation:
Department of Anesthesia, Stanford University School of Medicine, Stanford, CA, USA
Ethan Jackson
Affiliation:
Clinical Assistant Professor of Cardiothoracic Anesthesia; Director of Intraoperative Transesophageal Echocardiography; Division Chief of Adult Congenital Cardiothoracic Anesthesia, Stanford University, Medical Center, Lucille Packard Children's Hospital Stanford, CA, USA
David R. Gambling
Affiliation:
University of California, San Diego
M. Joanne Douglas
Affiliation:
University of British Columbia, Vancouver
Robert S. F. McKay
Affiliation:
University of Kansas
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Summary

Introduction

This chapter will outline the physiological changes, hemodynamic goals, management, and anesthetic options with regards to patients with acquired or congenital structural heart disease during pregnancy, labor, and delivery. There is no consensus as to the optimal anesthetic technique for the conditions being discussed. General and regional anesthesia can have significant cardiovascular effects on a parturient with cardiac disease. In addition, many pharmacological agents commonly used in anesthetic and obstetric practice can have adverse hemodynamic effects (Table 1.1).

Due to the nature and the rarity of the cardiac diseases discussed, there is a lack of randomized controlled studies to guide our practice. As a result, case reports and expert opinion will form the basis of discussing the anesthetic techniques. However, management options and anesthetic techniques must be individualized and based on the prevailing hemodynamic condition and obstetric needs.

Scope of the problem

An estimated 0.2–3.0% of pregnant patients have cardiac disease, an increasing cause of maternal mortality. The 2000– 2 Confidential Enquiries into Maternal Deaths in the United Kingdom reported that cardiac disease was the second most common nonobstetric cause of maternal death after psychiatric disease. Cardiac disease is also more common than the leading direct causes of maternal death. The maternal mortality rate ranges from 0.4% in New York Heart Association (NYHA) class I–II women to 6.8% in class III–IV (Tables 1.2 and 1.3).

Type
Chapter
Information
Obstetric Anesthesia and Uncommon Disorders , pp. 1 - 28
Publisher: Cambridge University Press
Print publication year: 2008

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  • Structural heart disease in pregnant women
    • By Brendan Carvalho, Department of Anesthesia, Stanford University School of Medicine, Stanford, CA, USA, Ethan Jackson, Clinical Assistant Professor of Cardiothoracic Anesthesia; Director of Intraoperative Transesophageal Echocardiography; Division Chief of Adult Congenital Cardiothoracic Anesthesia, Stanford University, Medical Center, Lucille Packard Children's Hospital Stanford, CA, USA
  • Edited by David R. Gambling, University of California, San Diego, M. Joanne Douglas, University of British Columbia, Vancouver, Robert S. F. McKay, University of Kansas
  • Book: Obstetric Anesthesia and Uncommon Disorders
  • Online publication: 19 October 2009
  • Chapter DOI: https://doi.org/10.1017/CBO9780511544552.002
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  • Structural heart disease in pregnant women
    • By Brendan Carvalho, Department of Anesthesia, Stanford University School of Medicine, Stanford, CA, USA, Ethan Jackson, Clinical Assistant Professor of Cardiothoracic Anesthesia; Director of Intraoperative Transesophageal Echocardiography; Division Chief of Adult Congenital Cardiothoracic Anesthesia, Stanford University, Medical Center, Lucille Packard Children's Hospital Stanford, CA, USA
  • Edited by David R. Gambling, University of California, San Diego, M. Joanne Douglas, University of British Columbia, Vancouver, Robert S. F. McKay, University of Kansas
  • Book: Obstetric Anesthesia and Uncommon Disorders
  • Online publication: 19 October 2009
  • Chapter DOI: https://doi.org/10.1017/CBO9780511544552.002
Available formats
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  • Structural heart disease in pregnant women
    • By Brendan Carvalho, Department of Anesthesia, Stanford University School of Medicine, Stanford, CA, USA, Ethan Jackson, Clinical Assistant Professor of Cardiothoracic Anesthesia; Director of Intraoperative Transesophageal Echocardiography; Division Chief of Adult Congenital Cardiothoracic Anesthesia, Stanford University, Medical Center, Lucille Packard Children's Hospital Stanford, CA, USA
  • Edited by David R. Gambling, University of California, San Diego, M. Joanne Douglas, University of British Columbia, Vancouver, Robert S. F. McKay, University of Kansas
  • Book: Obstetric Anesthesia and Uncommon Disorders
  • Online publication: 19 October 2009
  • Chapter DOI: https://doi.org/10.1017/CBO9780511544552.002
Available formats
×