Transesophageal echocardiography: a useful monitor for the anesthetic management of cesarean section in a woman with dilated cardiomyopathy

Abstract

Both peripartum cardiomyopathy (PPCM) and idiopathic dilated cardiomyopathy (IDCM) should be considered in pregnant patients presenting with symptoms of congestive heart failure.’ Cardiovascular changes associated with pregnancy, such as an increase in total blood volume and cardiac output, peak early in the third trimester and, for a second time, during labor and immediately after delivery.* These changes progressively stress cardiac reserve and may contribute to overt compromise of pump performance in patients with preexisting heart disease. Therefore patients suffering from IDCM, as was our patient, usually present with signs of acute cardiac decompensation before or during the third trimester of pregnancy.3 In contrast, patients with PPCM present with signs of cardiac failure in the last month of pregnancy or, in the majority of cases, during the 6 months after childbirth.4-6 We report the case of a woman who developed congestive heart failure early in the third trimester of pregnancy. We present our experience with twodimensional transesophageal echocardiography (TEE) used as a monitor of cardiac function and intravascular volume status during operative delivery. These findings are supplemented by echocardiographic data acquired during the initial clinical assessment and a follow-up 3 months after delivery. The patient was a 28year-old gravida 4 para 2, 153 cm, 65 kg woman who presented at 28 weeks gestation with orthopnea, shortness of breath and dyspnea on exertion. She had received no antenatal care because, as a refugee from Albania, she was