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Management bei kardialer Hochrisikoschwangerschaft

Sectio bei einer I. Gravida mit zyanotischem Vitium

Management of cardiac high risk pregnancy

Caesarean section in a primagravida with cyanotic cardiac defect

Der Anaesthesist volume 60, pages 57–62 (2011)Cite this article

Zusammenfassung

Schwangere mit angeborenem, komplexem zyanotischen Herzfehler haben ein hohes Morbiditäts- und Mortalitätsrisiko. Die Frage, ob ein regionalanästhesiologisches Verfahren Vorteile gegenüber allgemeinanästhesiologischen Verfahren bietet, kann aus der Literatur nicht eindeutig beantwortet werden. Es wird über eine 37-jährige I. Gravida mit teilweise korrigiertem, komplexem zyanotischen Herzfehler mit Pulmonalklappenatresie und einem Ventrikelseptumdefekt berichtet. Die Patientin wurde in der 31. SSW per Sectio in Regionalanästhesie entbunden. Für die Sectio erhielt sie ein invasives Monitoring, bestehend aus einer arteriellen und zentralvenösen Druckmessung und einem lumbalen Periduralkatheter (PDK). Die Sectio wurde ohne Komplikationen durchgeführt. Das interdisziplinäre Management ermöglichte die erfolgreiche Versorgung bei dieser kardialen Hochrisikoschwangerschaft. Für die Sectio bei einer kardialen Hochrisikoschwangeren scheint ein regionalanästhesiologisches Vorgehen trotz gegenteiliger Aussagen in der Literatur möglich zu sein.

Abstract

A 37-year-old gravida I with cyanotic heart disease presented for caesarean section in the 31st week of gestation. Caesarean section was performed uneventfully with the patient under epidural anaesthesia accompanied by invasive monitoring. Postoperative echocardiography showed no change in the shunt fraction, volumes or the ventricular function. Every patient with complex comorbidities has to be managed according to individual prerequisites and the experiences and preferences of the team. For such high risk pregnancies regional anaesthesia seems to be a possible option although no clear evidence can be found in the literature.

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Literatur

  1. Bédard E, Dimopoulos K, Gatzoulis MA (2009) Has there been any progress made on pregnancy outcomes among women with pulmonary arterial hypertension? Eur Heart J 30:256–265

    Article  PubMed  Google Scholar 

  2. Bonnin M, Mercier FJ, Sitbon O et al (2005) Severe pulmonary hypertension during pregnancy. Mode of delivery and anesthetic management of 15 consecutive cases. Anesthesiology 102:1133–1137

    Article  PubMed  Google Scholar 

  3. Braun U, Weyland A, Bartmus D et al (1996) Anesthesiologic aspects of pregnancy and delivery in a patient following a modified Fontan procedure. Anaesthesist 45(6):545–549

    CAS  Article  PubMed  Google Scholar 

  4. Breen T, Janzen J (1991) Pulmonary hypertension and cardiomyopathy: anaesthetic management for caesarean section. Can J Anaesth 38:895–899

    CAS  Article  PubMed  Google Scholar 

  5. Burn J, Brennan P, Little J et al (1998) Recurrence risks in offspring of adults with major heart defects: results from first cohort of British collaborative study. Lancet 351:311–316

    CAS  Article  PubMed  Google Scholar 

  6. Carp H, Jayaram A, Vahera R et al (1994) Epidural anesthesia for cesarean delivery and vaginal birth after Fontan repair: report of two cases. Anesth Analg 78:1190–1192

    CAS  Article  PubMed  Google Scholar 

  7. Chang J, Elam-Evans LD, Berg CJ et al (2003) Pregnancy-related mortality surveillance – United States, 1991–1999. MMWR Surveill Summ 52:1–8

    PubMed  Google Scholar 

  8. Cox PB, Gogarten W, Marcus MA (2005) Maternal cardiac disease. Curr Opin Anaesthesiol 18:257–262

    Article  PubMed  Google Scholar 

  9. Decoene C, Bourzoufi K, Moreau D et al (2001) Use of inhaled nitric oxide for emergency cesarean section in a woman with unexpected primary pulmonary hypertension. Can J Anaesth 48:584–587

    CAS  Article  PubMed  Google Scholar 

  10. Drenthen W, Pieper PG, Zoon N et al (2006) Pregnancy after biventricular repair for pulmonary atresia with ventricular septal defect. Am J Cardiol 98:262–266

    Article  PubMed  Google Scholar 

  11. Duggan AB, Katz SG (2003) Combined spinal and epidural anaesthesia for caesarean section in a parturient with severe primary pulmonary hypertension. Anaesth Intensive Care 31(5):565–569

    CAS  PubMed  Google Scholar 

  12. Erler I, Gogarten W (2007) Hypotonieprophylaxe und -therapie bei Regionalanästhesien zur Sectio caesaria. Anasthesiol Intensivmed Notfallmed Schmerzther 3:208–213

    Google Scholar 

  13. Task Force on the Management of Cardiovascular Diseases During Pregnancy of the European Society of Cardiology (2003) Expert consensus document on management of cardiovascular diseases during pregnancy. The task force on the management of cardiovascular diseases during pregnancy of the European society of cardiology. Eur Heart J 24:761–781

    Article  Google Scholar 

  14. Ghai B, Mohan N, Khetarpal M, Malhotra N (2002) Epidural anesthesia for caesarean section in a patient with Eisenmenger’s syndrome. Int J Obstet Anesth 11:44–47

    CAS  Article  PubMed  Google Scholar 

  15. Gogarten W, Aken H van (2000) A century of regional analgesia in obstetrics. Anest Analg 91:773–775

    CAS  Article  Google Scholar 

  16. Gogarten W, Aken H van, Büttner J et al (2007) Rückenmarknahe Regionalanästhesien und Thrombembolieprophylaxe/antithrombotische Medikation. Anaesthesiol Intensivmed 48:109–124

    Google Scholar 

  17. Gomar C, Errande CL (2005) Neuraxial anaesthesia in obstetrical patients with cardiac disease. Curr Opin Anaesthesiol 18:507–512

    Article  PubMed  Google Scholar 

  18. Hawkins JL (2003) Anesthesia-related maternal mortality. Clin Obstet Gynecol 46:679–687

    Article  PubMed  Google Scholar 

  19. Iserin L (2001) Management of pregnancy in women with congenital heart disease. Heart 85:493–494

    CAS  Article  PubMed  Google Scholar 

  20. Kuczkowski KM, van Zundert A (2007) Anesthesia for pregnant women with valvular heart disease: the state-of-the-art. J Anesth 21:252–257

    Article  PubMed  Google Scholar 

  21. Lovell AT (2004) Anaesthetic implications of grown-up congenital heart disease. Br J Anaesth 93:129–139

    CAS  Article  PubMed  Google Scholar 

  22. Madden BP (2001) Pulmonary hypertension and pregnancy. Int J Obstet Anesth 18:156–164

    Article  Google Scholar 

  23. Monnery L, Nanson J, Charlton G (2001) Primary pulmonary hypertension in pregnancy: a role for novel vasodilators. Br J Anaesth 87:295–298

    CAS  Article  PubMed  Google Scholar 

  24. Mook WN van, Peeters L (2005) Severe cardiac disease in pregnancy, part II: impact of congenital and acquired cardiac disease during pregnancy. Curr Opin Crit Care 11:435–448

    Article  PubMed  Google Scholar 

  25. Ngan Kee WD, Khaw KS, Tan PE et al (2009) Placental transfer and fetal metabolic effects of phenylephrine and ephedrine during spinal anesthesia for cesarean delivery. Anesthesiology 111:506–512

    Article  Google Scholar 

  26. Oakley CM (1997) Pregnancy and congenital heart disease. Heart 78(3):12–24

    CAS  PubMed  Google Scholar 

  27. Oakley CM (1990) Cardiovascular disease in pregnancy. Can J Cardiol 6 [Suppl B]:3–9

  28. Olofsson C, Bremme K, Forssell G, Ohqvist G (2001) Caesarean section under epidural ropivacaine 0.75% in a parturient with severe pulmonary hypertension. Acta Anaesthesiol Scand 45:258–260

    CAS  Article  PubMed  Google Scholar 

  29. Plicht B, Naber CK, Erbel R (2008) Therapy and prophylaxis of infective endocarditis. Internist 49(10):1219–1227

    CAS  Article  PubMed  Google Scholar 

  30. Presbitero P, Somervill J, Stone S et al (1994) Pregnancy in cyanotic congenital heart disease. Outcome of mother and fetus. Circulation 89:2673–2676

    CAS  PubMed  Google Scholar 

  31. Reidy J, Douglas J (2008) Vasopressors in obstetrics. Anesthesiol Clin 26:75–88

    CAS  Article  PubMed  Google Scholar 

  32. Schwarzenberger JC, Gogarten W (2007) Nichtherzchirurgische Eingriffe bei Kindern und Erwachsenen. Anasthesiol Intensivmed Notfallmed Schmerzther 42(11):822–832

    Article  PubMed  Google Scholar 

  33. Shimizu T, Takahashi H, Matsumiya N et al (2007) Unsuccessful anesthetic management for cesarean section in a patient with primary pulmonary hypertension. Masui 56(8):949–952

    PubMed  Google Scholar 

  34. Siu SC, Sermer M, Colman JM et al (2001) Prospective multicenter study of pregnancy outcomes in women with heart disease. Circulation 104:515–521

    CAS  Article  PubMed  Google Scholar 

  35. Stamer UM, Wiese R, Stüber F et al (2005) Change in anaesthetic practice for caesarean section in Germany. Acta Anaesthesiol Scand 49:170–176

    CAS  Article  PubMed  Google Scholar 

  36. Van de Velde M, De Buck F (2007) Anesthesia for non-obstetric surgery in the pregnant patient. Minerva Anestesiol 73:235–240

    Google Scholar 

  37. Weiss BM, Hess OM (2000) Pulmonary vascular disease and pregnancy: current controversies, management and perspectives. Eur Heart J 21:104–105

    CAS  Article  PubMed  Google Scholar 

  38. Wilson W, Taubert KA, Gewitz K et al (2008) Prevention of infective endocarditis: guidelines from the American Heart Association. A guideline from the American Heart Association Rheumatic Fever, Endocarditis and Kawasaki Disease Committee, Council on Cardiovascular Disease in the Young, and the Council on Clinical Cardiology, Council on Cardiovascular Surgery and Anesthesia, and the Quality of Care and Outcomes Research Interdisciplinary Working Group. J Am Dent Assoc 139 [Suppl]:3–24

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Affiliations

  1. Klinik für Anästhesiologie mit Schwerpunkt operative Intensivmedizin, Charité – Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Deutschland

    S. Kramer,  T. Schröder, M. Schuster & I. Correns

  2. Medizinische Klinik mit Schwerpunkt für Kardiologie und Angiologie, Charité – Universitätsmedizin Berlin, Berlin, Deutschland

    V. Stangl & W. Sanad

  3. Klinik für Anästhesiologie, Intensivmedizin und Schmerztherapie, Universitätskliniken des Saarlandes, Homburg/Saar, Deutschland

    T. Volk

Authors
  1. S. Kramer
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  2. T. Schröder
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  3. M. Schuster
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  4. V. Stangl
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  5. I. Correns
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  6. W. Sanad
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  7. T. Volk
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Correspondence to T. Schröder.

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Kramer, S., Schröder, T., Schuster, M. et al. Management bei kardialer Hochrisikoschwangerschaft. Anaesthesist 60, 57–62 (2011). https://doi.org/10.1007/s00101-010-1741-7

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  • DOI: https://doi.org/10.1007/s00101-010-1741-7

Schlüsselwörter

  • Zyanotisches Vitium
  • Pulmonaler Hypertonus
  • Hochrisikoschwangerschaft
  • Periduralanästhesie
  • Sectio

Keywords

  • Cyanotic heart disease
  • Pulmonary hypertension
  • High risk pregnancy
  • Epidural anaesthesia
  • Caesarean section