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HYPERTROPHIC CARDIOMYOPATHY WITH SEVERE OBSTRUCTION DIAGNOSED DURING PREGNANCY : ANESTHETIC MANAGEMENT
ESRA Academy. Gomez-Diago L. Sep 8, 2016; 138409
Topic: Obstetric Population
Lorena Gomez-Diago
Lorena Gomez-Diago

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Abstract
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Background and Aims:

Hypertrophic cardiomyopathy(HCM) is a rare condition. It may be complicated with syncope, atrial or ventricular arrhythmias and cardiac arrest episodes.The fetal prognosis in most cases is not affected by maternal HCM. In patients with symptoms of obstruction of the outflow, the second stage of labor should be shortened using instrumentation.

Methods:

A primigravida 31-year-old with no medical history and asymptomatic. At 34weeks an EKG is performed for the preanesthesia test and an IRBBB with ventricular extrasitoles are detected. Echocardiography shows: HCM with a basal septum of 26mm. Systolic anterior motion with left ventricular outflow tract obstruction up to 120mmHg.Ending the gestation as soon as possible and bisoprolol 1.25 mg/24h are recommended by cardiologist. 

Results:

An elective cst is scheduled at 38weeks. A central line in right subclavia and left radial arterial catheter are placed under local anesthesia. A PiccoPlus(r) is used for invasive haemodynamic monitoring. Anesthesia induction is performed with sevoflurane and a continuous perfusion of remifentanil intravenous. After induction: CI 2,81 SVR 3200 CFI 5 ELWI 8,2. Arterial pressure 110/60mmHg; HR 70 bpm. Sat02(Fi02 50%) 100%. Sevoflurane 1.5CAM and remifentanil are used of maintenance. Fetal extraction was done with Apgar 9/10 and pH 7.30. 10UI of oxytocin are administered in continuos perfusion to prevent uterine atony.The patient is transferred to Critical Care Unit (10 points in Aldrete score) and discharged after 48h. 

Conclusions:

A complete cardiological study to all obstetric patients whom presenting electrocardiographic abnormalities is necessary.
The management should avoid cardiac decompensation and it must be multidisciplinary (obstetrician, cardiologist and anesthesiologist)


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