Philippine Journal of Anesthesiology 2008;20(1):19-18

Anesthesia care for three lives entwined to a failing heart (twin pregnancy in a parturient with severe mitral stenosis)

Padilla Eric ; Jamora Vanessa

Country

Philippines

Language

English

Abstract

We present a case of a 20 year old patient with twin pregnancy 25-26 weeks AOG on top of a reexisting mitral stenosis in congestive heart failure accompanied by comunity acquired pneumonia; questionable asthma and gestational diabetes mellitus. The physiologic changes associated with twin pregnancy such as increaased blood volume, cardiac output, heart rate and a decrease in systemic vascular resistance are conflicting with the requirements of mitral stenosis, thus down grading the mitral stenosis to NYHA class IVD. Anesthesia was provided with continuous lumber epidural anesthesia using isobaric bupivacaine 0.5% under vigilant and invasive monitoring. Central venous pressure was monitored and maintained to normal with judicious fluid administration and diuresis. Epidural morphine was given for postoperative pain control.