Abstract
Holt–Oram syndrome is a rare autosomal dominant disorder characterized by skeletal upper-limb dysplasias and congenital cardiac defects. Clinical manifestations of this syndrome vary, and range from sub clinical radiologic findings to overt, life-threatening disease. The author of this article reports safe and effective use of low dose sequential combined spinal and epidural anaesthesia for caesarean section in a parturient with Holt–Oram syndrome and automatic implantable cardioverter defibrillator (AICD). Concerns with regards to anaesthetic management include problems with vascular access, possible arrhythmias, the presence of an AICD, and the possibility of cardiovascular instability. The characteristics of this syndrome and anaesthetic implications are discussed.
References
Lichiardopol C, Militaru C, Popescu B, Hila G, Mixich F (2007) Holt–Oram syndrome. Rom J Morphol Embryol 48:67–70
Bossert T, Walther T, Gummert J et al (2002) Cardiac malformations associated with the Holt–Oram syndrome—report on a family and review of the literature. Thorac Cardiovasc Surg 50:312–314. doi:10.1055/s-2002-34573
Holt M, Oram S (1960) Familial heart disease with skeletal malformations. Br Heart J 22:236–242. doi:10.1136/hrt.22.2.236
Shano S, Higa K, Kumano K, Dan K (1998) Holt–Oram syndrome. Br J Anaesth 80:856–857
White S, Parry M, Henderson K (2003) Anaesthesia for total hip replacement in a patient with Holt–Oram syndrome. Eur J Anaesthesiol 20:336–338. doi:10.1017/S0265021503240515
Ioscovich A, Akoury H, Sternberg L, Halpern S (2007) Anesthesia for cesarean section in a patient with Holt–Oram syndrome. Int J Obstet Anesth 16:86–88. doi:10.1016/j.ijoa.2006.08.010
Tucker KJ, Murphy J, Conti JB, Curtis AB (1994) Syncope and sinus arrest with the upper limb-cardiovascular (Holt–Oram) syndrome. Pacing Clin Electrophysiol 17:1678–1680. doi:10.1111/j.1540-8159.1994.tb02364.x
Ekure EN, Okoromah CN, Briggs E, Ajenifuja OA (2004) Holt–Oram syndrome with hypoplastic left heart syndrome in an African child. Niger Postgrad Med J 11:190–192
Crowley LJ, Buggy DJ (2008) Shivering and neuraxial anesthesia. Reg Anesth Pain Med 33:241–252. doi:10.1016/j.rapm.2007.11.006
Salukhe TV, Dob D, Sutton R (2004) Pacemakers and defibrillators: anaesthetic implications. Br J Anaesth 93:95–104. doi:10.1093/bja/aeh170
Hamlyn EL, Douglass CA, Plaat F, Crowhurst JA, Stocks GM (2005) Low dose sequential combined spinal–epidural: an anaesthetic technique for caesarean section in patients with significant cardiac disease. Int J Obstet Anesth 14:355–361. doi:10.1016/j.ijoa.2005.01.001
Ngan Kee WD, Khaw KS, Ng FF, Lee BB (2004) Prophylactic phenylephrine infusion for preventing hypotension during spinal anaesthesia for caesarean delivery. Anesth Analg 98:815–821. doi:10.1213/01.ANE.0000099782.78002.30
Conflict of interest statement
No actual or potential conflict of interest in relation to this article.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Kanniah, S.K. Caesarean delivery in a parturient with Holt–Oram syndrome and implantable cardioverter defibrillator: anaesthetic considerations. Arch Gynecol Obstet 280, 111–113 (2009). https://doi.org/10.1007/s00404-008-0854-6
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00404-008-0854-6