Low-dose Fractionated Spinal Anaesthesia for Elective Caesarean Section in a Patient with Large Atrial Septal Defect, Severe Pulmonary Hypertension and Preeclampsia: A Case Report
UD01-UD03
Correspondence
Dr. Lisa Barman,
Senior Resident, Department of Anaesthesia, Pt. B.D. Sharma PGIMS, Rohtak-124001, Haryana, India.
E-mail: barmanlisa8@gmail.com
Atrial Septal Defect (ASD) is one of the most common acyanotic heart diseases presented in adults, with a higher prevalence among females. Patients often go unrecognised until middle age, unless complications such as arrhythmias arise. The physiological changes during pregnancy cause significant alterations in maternal haemodynamics. Cardiac valvular diseases, when present in obstetric patients, are among the leading causes of maternal mortality worldwide. These conditions pose a significant and unanticipated anaesthetic challenge, as the shunting of blood from left to right may precipitate hypoxia, hypercarbia, arrhythmias and cardiac failure. The presence of any other co-morbidities further complicates management. Hereby, the authors reported the successful management of a 30-year-old primigravida female at eight months of pregnancy, associated with a large ASD (34 mm), severe pulmonary hypertension, and preeclampsia, who underwent an elective Caesarean section (C-section). She presented at the Obstetric Emergency Department with dyspnoea at rest, which progressively deteriorated from the second month of pregnancy onward. She had no other complaints during her pregnancy. Echocardiography revealed a large Ostium Secundum ASD (OS-ASD) measuring 34 mm, almost leading to a single atrium physiology, with an ejection fraction of 45% and grossly dilated right atrium and right ventricle, as well as, severe Pulmonary Artery Hypertension (PAH). She underwent an elective Caesarean section with minimal haemodynamic alterations under fractionated spinal anaesthesia, with prophylactic adrenaline infusion. The effects were found to be beneficial and safe for the Caesarean section in patients with large ASD and preeclampsia.