26 Y F WITH 36 WEEK PREGNANCY KNOWN CASE OF RHEUMATIC HEART DISEASE WITH MITRAL STENOSIS POSTED FOR ELECTIVE LSCS
PATHOPHYSIOLOGY OF MITRAL STENOSIS
ANESTHESIA PLAN
PATHOPHYSIOLOGY OF MITRAL STENOSIS
Mitral valve stenosis is reduced valve area < 2 cm ²
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Reduced valve area causes impediment in blood flow across the valve
⬇ Reduced left ventricular diastolic filing becomes dependent on atrial kick ⬇ As Transvalvular Pressure increases the transmitted Left Atrial Pressure rises ⬇
Left Atrial enlargement leading to Atrial fibrillation ⬇Increased pulmonary artery Pressure, and Pulmonary Artery Hypertension ⬇Reduced cardiac output and Congestive Heart Failure ANESTHESIA PLAN
Preoperative concerns Symptoms of breathlessness, fatigue,lower respiratory tract infectionEvidence of right heart failure- raised Jugular Pulse, pedal oedemaLeft atrial enlargement prone to atrial fibrillationIf on warfarin to be bridged to heparin InvestigationsEcg has P mitrale2D ECHO PASP is a vital indicatorPerioperative management- Fixed cardiac condition-Sinus Rhythm to be maintained
- Rate low (<70/min) avoid tachycardia
- Preload maintenance ,overload to avoid
- Afterload maintenance, it can reduce with decreased systemic vascular resistance
- Pulmonary vascular pressure to be maintained by avoiding hypoxia, hypercapnia and acidosis
Regional anaesthesia in form of epidural and continuous spinal has emerged as a safe technique has the advantage of titrated and incremental dose. The onset of anaesthesia is gradual allows for cardiovascular compensation is for sympathetic blockade is and decreases reduced uteroplacental perfusion
- Fixed cardiac condition-Sinus Rhythm to be maintained
- Rate low (<70/min) avoid tachycardia
- Preload maintenance ,overload to avoid
- Afterload maintenance, it can reduce with decreased systemic vascular resistance
- Pulmonary vascular pressure to be maintained by avoiding hypoxia, hypercapnia and acidosis
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