Pregnancy and heart disease present a unique challenge to the anesthesiologist. Pregnancy results in physiological changes to the parturient's cardiovascular system that can unmask or worsen underlying heart disease. To avoid untoward complications resulting in significant maternal and/or fetal morbidity or mortality, the anesthesiologist must be knowledgeable about the progression of heart disease during pregnancy. Discussed are the pathophysiology, clinical presentation, and anesthetic management of valvular, congenital, vascular, and ischemic heart disease, and cardiomyopathy in pregnancy.
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References
1.
1. Szekely P, Snaith L: Atrial fibrillation and pregnancy. Br Med J1:1407-1410, 1961.
3. McCaffrey FM, Sherman FS: Pregnancy and congenital heart disease: The Magee-Women's Hospital. J Matern Fetal Med4:152-159, 1995.
4.
4. Shime J, Mocarski EJM, Hastings D, et al: Congenital heart disease in pregnancy: Short and long term implications. Am J Obstet Gynecol156:313-322, 1989.
5.
5. Ueland K, Hansen J: Maternal cardiovascular dynamics III. Labor and delivery under local and caudal analgesia. Am J Obstet Gynecol104:856-864, 1969.
6.
6. Al Kasab SM, Sabag T, al Zaibag M, et al: Beta-adrenergic receptor blockade in the management of pregnant women with mitral stenosis. Am J Obstet Gynecol163:37-40, 1990.
7.
7. Ziskind Z, Etchin A, Frenkel Y, et al: Epidural anesthesia with the Trendelenburg position for cesarean section with or without a cardiac surgical procedure in patients with severe mitral stenosis. A hemodynamic study. J Cardiothorac Anesth4:354-359, 1990.
8.
8. Lynch C III, Rizor RF: Anesthetic management and monitoring of a parturient with mitral and aortic valvular disease. Anesth Analg61:788-792, 1982.
9.
9. Clark SL, Phelan JP, Greenspoon J, Aldahl D, et al: Labor and delivery in the presence of mitral stenosis: Central hemodynamic observations. Am J Obstet Gynecol152:984-988, 1985.
10.
10. Baxley WA, Kennedy JW, Field B, Dodge HT: Hemodynamics in ruptured chordae tendinae and chronic rheumatic mitral regurgitation. Circulation50:1025-1032, 1974.
11.
11. Shapiro EP, Trimble EL, Robinson JC, Estruch MT, et al: Safety labor and delivery in women with mitral valve prolapse. Am J Cardiol56:806-807, 1985.
12.
12. Ueland K, Novy MJ, Metcalfe J: Hemodynamic responses of patients with heart disease to pregnancy and exercise. Am J Obstet Gynecol113:47-59, 1972.
13.
13. Szekely P, Snaith L (eds): Heart Disease and Pregnancy. London, Churchill Livingstone, 1974.
14.
14. Burwell CS, Metcalfe J, (eds): Heart Disease and Pregnancy. Boston, MA. Little Brown, 1958, pp 210-220
15.
15. Snaith L, Szekely P: Cardiovascular surgery in relation to pregnancy, in Marcus S, Marcus C, (eds): Advances in Obstetrics and Gynecology. Baltimore, MD, Williams and Wilkins, 1967, p 220-220.
16.
16. Cannell DE, Vernon CP: Congenital heart disease and pregnancy. Am J Obstet Gynecol85:744-753, 1961.
17.
17. Rudolph AM (ed): Congenital Diseases of the Heart. Chicago, IL, Year Book Medical Publishers, 1974.
18.
18. Dunborg G, Broustet P, Bricaud H, Fontan F, et al: Correction complete d'une triade de Fallott en Circulation extracorporelle chez une femme enceinte. Arch Mal Coeur52:1389-1391, 1959.
19.
19. Baker JL, Russell CS, Grainger RG, Taylor DG, et al: Closed pulmonary valvotomy in the management of Fallot's tetralogy complicated by pregnancy. J Obstet Gynaecol Br Commonw70:154-157, 1963.
20.
20. Clarkson PM, Wilson NJ, Neutze JM, North RA, et al: Outcome of pregnancy after the Mustard operation for transposition of the great arteries with intact ventricular septum. J Am Coll Cardiol24:190-193, 1994.
21.
21. Dizon-Townson D, Magee KP, Twickler DM, Cox SM. Coarctation of the abdominal aorta in pregnancy: Diagnosis by magnetic resonance imaging. Obstet Gynecol85:817-819, 1995.
22.
22. Goodwin JF: Pregnancy and coarctation of the aorta. Clin Obstet Gynecol4:645-664, 1961.
23.
23. Deal K, Wooley CF: Coarctation of the aorta and pregnancy. Ann Intern Med78:706-713, 1973.
24.
24. Campbell M.The incidence and later distribution of malformations of the heart, in Watson H (ed). Pediatric Cardiology. London: Lloyd-Luke, 1968, p 71-71.
