Anesthetic Management

Challenges in Anesthetic Management of Severe cardiac problem patient coming for Caesarian section

Dr Manoj Gupta, Dr Anu Sehgel

Department of Anesthesia, Metro Heart Institute and Multispeciality Hospital, Faridabad


Rheumatic heart disease is cardiac inflammation and scarring triggered by an autoimmune reaction to infection with group A streptococci.  Chronic disease is manifested by valvular fibrosis, resulting in stenosis and/or insufficiency. Rheumatic fever is rare before age 5 years and after age 25 years;  The highest incidence is observed in children aged 5-15 years and in underdeveloped or developing countries where antibiotics are not routinely dispensed for pharyngitis and where compliance is low.[1] Although rheumatic fever was previously the most common cause of heart valve replacement or repair, this disease is currently relatively uncommon, trailing behind the incidence of aortic stenosis due to degenerative calcific disease, bicuspid aortic valve disease, and mitral valve prolapse that requires the best Cardiologist in Delhi/NCR.

Rheumatic heart disease is the predominant cause of mitral stenosis. A history of rheumatic fever can be elicited from approximately 60% of patients presenting with pure mitral stenosis.[11] There is a 2:1 female-to-male incidence.


A Patient 30 year old female admitted with complaints of pain in the abdomen at 37 weeks pregnancy in metro hospital Faridabad. On clinical history and examination, she was found to be a known case of Rheumatic heart disease and her cardiac function was compromised. Her 2 D Echo was done which shows severe Mitral stenosis Mitral Valve area was less than 1 Cm2 with moderate MR and Severe Pulmonary artery hypertension, EF was 55%. she has undergone PTMC procedure for the cardiac problem in 2009. She was known the case of hypothyroidism for which she was taking treatment.  Her thyroid profile was under control. Rest of her blood investigation CBC, PT INR KFT, Viral Marker, ECG done which was normal, She is planned for Caesarian section and delivery of her baby.

Doing Caesarian section in such patient there is a risk of cardiac failure pulmonary edema during anesthesia and surgery. And life risk to both mother and baby.

After Pre- anesthetic examination, informed consent was taking and standard guidline for fasting was followed and planned for caeserian section. We planed General anesthesia for this patient, usual caeserian section done under spinal anesthesia, but because of her cardiac condition GA was planned.

Standard monitoring ECG SPO2 RR NIBP done, special monitoring Invasive blood monitoring also done by accessing arterial pressure monitoring by putting radial artery cannula. We use Glycopyrrolate, emeset, etomidate, atracurium, fentanyl, betaloc, for anesthesia. For Securing the Air Way I Gel 4# was used. And maintain on Oxygen nitrous oxide and sevoflurane. Paracetamol was given for post op analgesia. Patient remain stable throughout surgery. There was no episode of hypotension during surgery. Both baby and mother remain stable post operatively and patient was monitored in post operative care for next 3-4 hrs and shifted to CCU for further care.  Next day shifted to ward and discharge on 4th day of surgery in satisfactory condition.


Metro heart institute and multispeciality hospital Faridabad is the best Heart hospital Delhi NCR. That’s why lots of patient coming for different surgeries with cardiac problem. We are managing such patient successfully during surgery and good post operative cardiac backup.