Case Report: Anesthetic Management in Pregnant Woman with Severe Pulmonary Hypertension

Abstract

Pulmonary hypertension is a disease of low prevalence that can affect women of childbearing age; however, it is the cardiovascular disease with the highest maternal mortality, up to 56%. Timely counseling and optimization of care during pregnancy and the peripartum period have reduced maternal mortality. We present the case of a 41-year-old female patient with a history of unspecified heart disease of 10 years of evolution without medical treatment and congenital hypoplasia of the right thoracic limb. She came to the emergency department with pregnancy of 22.3 weeks of gestation, dyspnea of medium efforts, peribuccal cyanosis and pulmonary murmur, so a transthoracic echocardiogram was performed at rest that reported moderate tricuspid insufficiency/mild aortic insufficiency/moderate pulmonary insufficiency with high probability of pulmonary hypertension, so it was suggested to interrupt the pregnancy via abdominal, which was denied by the patient and a referral to third level of care was made. Patient was readmitted at 34 weeks of gestation with dyspnea on small efforts and labor in latent phase, so an emergency cesarean section was performed, with anesthetic management with fractionated peridural block, leaving the room with spontaneous ventilation, without vasopressor support to ICU, which later presented a torpid evolution until death.