Graded epidural anaesthesia for caesarean section in a parturient with severe left ventricular dysfunction from dilated cardiomyopathy: A case report

Abstract

Dilated cardiomyopathy (DCM) is a primary disorder of heart muscle characterised by left ventricular (LV) or biventricular dilatation and impaired ventricular contractility. During pregnancy, women with DCM have a higher incidence of cardiac events than the non-pregnant patient. When DCM is associated with severe LV dysfunction, anaesthetic management is particularly challenging, because severe LV dysfunction is a predictor of sudden cardiac death and poor quality of life. The goals of anaesthetic management in DCM consist of maintaining normovolaemia, and avoiding myocardial depression and drug overdose during induction (as circulation time is slow). It also includes preventing increases in ventricular afterload and sudden hypotension when regional anaesthesia is a choice. This case report describes the successful anaesthetic management of a parturient with DCM and a severely low LV ejection fraction of 20%, wherein the child was delivered via caesarean section using a graded epidural anaesthesia technique.