Abstract
Peripartum cardiomyopathy (PPCM) is a form of dilated cardiomyopathy which presents unique challenges for anaesthetic management. Here we present a case of PPCM who was given low dose spinal anaesthesia with TAP block for caesarean section which is rarely reported. A 33-year-old multigravida, 35 weeks gestation presented with PPCM with ejection fraction of 24%. Elective caesarean section was planned in view of worsening dyspnoea despite treatment. Graded epidural anaesthesia with invasive monitoring was planned but we encountered a bloody tap whilst securing the epidural catheter, hence switched to low dose spinal anaesthesia (6mg of 0.5% bupivacaine+10mcg of fentanyl). Ultrasound guided bilateral TAP block was given for post-operative analgesia. We observed that the patient had a comfortable and haemodynamically stable experience intra and post operatively. Hence a low dose spinal anaesthesia and TAP block with invasive monitoring can be opted as an anaesthetic technique in PPCM.
Highlights
Anaesthetic goal of maintaining optimal ventricular preload and afterload while avoiding anaesthesia induced vasodilatation and myocardial depression makes peripartum cardiomyopathy (PPCM) challenging for anaesthesiologists
We report a case of PPCM who underwent caesarean section (CS) under single shot low-dose spinal anaesthesia and transversus abdominis plane (TAP) block following a failed epidural catheter insertion
The Heart failure Association of the European Society of Cardiology working group have defined PPCM as “an idiopathic cardiomyopathy presenting with heart failure secondary to left ventricular systolic dysfunction towards the end of pregnancy or in the months following delivery where no other cause of heart failure is found
Summary
Anaesthetic goal of maintaining optimal ventricular preload and afterload while avoiding anaesthesia induced vasodilatation and myocardial depression makes peripartum cardiomyopathy (PPCM) challenging for anaesthesiologists. Peripartum dilated cardiomyopathy was diagnosed following echocardiography which showed globally hypokinetic left ventricle, severe left ventricular systolic dysfunction with an ejection fraction of 24%, severe mitral regurgitation, moderate to severe pulmonary artery hypertension and moderate tricuspid regurgitation She gave a history of undergoing CS twice before but had no history of any cardiac disease in the past. We gave bilateral TAP blocks with 20ml of 0.25% levo-bupivacaine on each side under ultrasound guidance Even though her cardiac function and ejection fraction did not improve drastically she was symptomatically better and after a period of 7 days she was discharged with advice to continue oral carvedilol, furosemide and warfarin and was asked to review after a month
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