PMID- 19733057
OWN - NLM
STAT- MEDLINE
DCOM- 20091207
LR  - 20161125
IS  - 1532-3374 (Electronic)
IS  - 0959-289X (Linking)
VI  - 18
IP  - 4
DP  - 2009 Oct
TI  - Peripartum anesthetic management of patients with aortic valve stenosis: a 
      retrospective study and literature review.
PG  - 379-86
LID - 10.1016/j.ijoa.2009.02.019 [doi]
AB  - BACKGROUND: Anesthetic management of parturients with aortic stenosis is 
      controversial. Early studies suggest maternal mortality was related to cardiac 
      condition and anesthetic care. In this report, management of parturients with 
      moderate or severe aortic stenosis in two institutions is compared, and published 
      cases are reviewed. METHODS: Peripartum anesthetic management of all parturients 
      with moderate or severe aortic stenosis who gave birth between 1990 and 2005 at 
      our institutions, is described. Patients with mild or non-valvular aortic 
      stenosis were excluded. RESULTS: There were 12 parturients, six with moderate and 
      six with severe aortic stenosis. Two patients with moderate aortic stenosis were 
      New York Heart Association (NYHA) classification II, the others were 
      asymptomatic. Five patients with severe aortic stenosis were symptomatic (NYHA 
      classification II or III). Two patients with moderate and three with severe 
      aortic stenosis underwent cesarean delivery; epidural anesthesia was used for 
      two. Two patients with moderate and all with serious aortic stenosis were 
      observed postpartum for 24 to 48 h in a high-dependency unit. There were no 
      severe maternal or neonatal complications. CONCLUSIONS: Carefully titrated 
      regional analgesia is usually well tolerated in patients undergoing vaginal or 
      cesarean delivery even in the presence of severe aortic stenosis. Standard 
      monitoring is usually adequate for vaginal delivery, but invasive monitoring may 
      facilitate management in some patients. An arterial line allows close monitoring 
      of systemic blood pressure. Facilities for close 24-48-h post-partum observation 
      should be available. A multidisciplinary approach is needed.
FAU - Ioscovich, A M
AU  - Ioscovich AM
AD  - Department of Anesthesia, Sunnybrook Health Sciences Centre, Mount Sinai 
      Hospital, Toronto, Canada. aioscovich@gmail.com
FAU - Goldszmidt, E
AU  - Goldszmidt E
FAU - Fadeev, A V
AU  - Fadeev AV
FAU - Grisaru-Granovsky, S
AU  - Grisaru-Granovsky S
FAU - Halpern, S H
AU  - Halpern SH
LA  - eng
PT  - Journal Article
PT  - Meta-Analysis
PT  - Review
DEP - 20090903
PL  - Netherlands
TA  - Int J Obstet Anesth
JT  - International journal of obstetric anesthesia
JID - 9200430
RN  - 0 (Vasoconstrictor Agents)
SB  - IM
MH  - Adult
MH  - Anesthesia, Epidural
MH  - Anesthesia, General
MH  - Anesthesia, Obstetrical/*adverse effects
MH  - Aortic Valve Stenosis/*complications/diagnostic imaging/physiopathology
MH  - Apgar Score
MH  - Electrocardiography
MH  - Female
MH  - Gestational Age
MH  - Hemodynamics
MH  - Humans
MH  - Infant, Newborn
MH  - Monitoring, Intraoperative
MH  - Parity
MH  - Postpartum Period
MH  - Pregnancy
MH  - *Pregnancy Complications, Cardiovascular
MH  - Pregnancy Outcome
MH  - Retrospective Studies
MH  - Ultrasonography
MH  - Vasoconstrictor Agents/adverse effects/therapeutic use
RF  - 33
EDAT- 2009/09/08 06:00
MHDA- 2009/12/16 06:00
CRDT- 2009/09/08 06:00
PHST- 2009/02/25 00:00 [accepted]
PHST- 2009/09/08 06:00 [entrez]
PHST- 2009/09/08 06:00 [pubmed]
PHST- 2009/12/16 06:00 [medline]
AID - S0959-289X(09)00085-5 [pii]
AID - 10.1016/j.ijoa.2009.02.019 [doi]
PST - ppublish
SO  - Int J Obstet Anesth. 2009 Oct;18(4):379-86. doi: 10.1016/j.ijoa.2009.02.019. Epub 
      2009 Sep 3.