Anaesthetic Management of Patient with Hypertrophy Obstructive Cardiomyopathy Posted for Elective Caesarean

Abstract

Introduction: Dynamic valvular insufficiency and LVOT blockage are also possible outcomes of hypertrophic obstructive cardiomyopathy (HOCM). Furthermore, attempting to replace an inadequate mitral valve surgically can result in iatrogenic LVOT blockage. In the general population, it affects one out of every 500 adults, with a male to female ratio of 2:1. Among the general population, the prevalence is around 0.2 percent, and the incidence in pregnant women is around 0.1–0.5 percent. Case Report: 21 year old female patient presented with 9 months of amenorrhea posted for elective lower segment caesarean section. Her previous documents revealed that she was a diagnosed case of hypertrophic obstructive cardiomyopathy during her last pregnancy 1 year ago. History of previous surgery that is induced abortion at two and half months of gestation age a year back operated under spinal anaesthesia. ECG showed ST elevation present in V2 , V3, V4 , V5 leads and features of left ventricular hypertrophy (LVH) , Her echocardiography report revealed features of hypertrophic obstructive cardiomyopathy with severe LVOT obstruction. Left ventricular ejection fraction (LVEF) was 20-25%. Conclusion: HOCM is normally well tolerated during pregnancy, although those who have had previous symptoms or arrhythmias may experience an exacerbation of symptoms. The majority of these people, on the other hand, can be effectively controlled medically. This case report showed that patients with HOCM can be safely managed under general anaesthesia with muscle relaxants and inhalational volatile anaesthetics, as well as an erector spinae block for analgesia