2023 FSA Podium and Poster Abstracts

P012: ANESTHETIC CONSIDERATION FOR CARDIAC DISEASE IN PREGNANT PATIENTS
Emily Chung, DO; Katherine Medrano, MD; Kalina Nedeff, MD; Caleb Stalls, MD; Kendall Regional Medical Center

Introduction: A 36-year-old female with a past medical history of cyanotic congenital heart disease presented for induction of pregnancy. Her surgical history included mitral valve repair twice and placement of a pacemaker. Her only medications were prenatal vitamins and metoprolol.

Methods: Before induction of pregnancy, an electrocardiogram (ECG) and echocardiogram were ordered. Cardiology was consulted to interrogate the pacemaker to ensure proper function and retrieve data on any cardiac events that occurred. ECG, on admission, showed an atrial-sensed, ventricular-paced rhythm. ECG, during admission, showed atrial fibrillation. Echocardiogram showed an ejection fraction of 40-45% with mild mitral regurgitation and thickened anterior leaflet. Following the interrogation and imaging studies, the induction of labor proceeded. The patient was induced with oxytocin and a cervical ripening balloon. Once the patient was dilated about 6cm, an epidural catheter was placed for labor pains without any complications.

Results: After about 5 hours following the placement of the epidural catheter, the patient delivered spontaneously without any complications. She was later transported to the postpartum unit. She had an uneventful recovery and was discharged home two days later.

Discussion/Conclusion: Advancements in medicine and cardiac surgeries for corrections of complex congenital heart anomalies have made providing anesthesia to pregnant patients with heart disease an arduous task. The frequency with which these types of patients present is likely to increase in the near future due to the effective performance and innovations in cardiac surgery. In developing countries with a higher prevalence of rheumatic fever, cardiac disease may complicate as many as 5.9% of pregnancies with a high incidence of maternal death. Since many of these deaths occur during or immediately following parturition, heart disease is of special importance to the anesthesiologist.

This implication arises from the fact that drugs used for preventing or relieving pain during labor and delivery exert a major influence on the prognosis of the mother. Correctly administered anesthesia and analgesia impact the reduction of maternal and neonatal mortality and morbidity.

Overall maternal and fetal morbidity and mortality from cardiac disease are directly related to the severity of cardiac disease. Maternal mortality ranges from 0.4% in the New York Heart Association class I–II disease to 6.8% in class III–IV disease. The hazard to the mother with congenital heart disease varies on the type of malformation and the functional loss it produces. The major concern for a pregnant woman with cardiac disease is cardiac decompensation because of the incapacity to meet the additional demands enforced by the physiologic changes of pregnancy and parturition. It is crucial to understand the impact of the physiologic changes of pregnancy upon the heart lesion to appropriately advise and treat these patients. Pregnant women with heart disease should be managed by a team of professionals from obstetrics and perinatology, anesthesiology, neonatology, cardiology, cardiothoracic surgery, intensive care, nursing, and social work.