Graded epidural anaesthesia for Caesarean section in a parturient with Shone's syndrome: a case study

Abstract

Pregnancy with underlying heart disease is a unique challenge both to the obstetrician and the anesthesiologist. Asymptomatic women with mild to moderate single lesions can successfully carry a pregnancy to term and undergo vaginal delivery. However, pregnancy can result in rapid clinical deterioration, which may lead to maternal and/or foetal mortality in symptomatic patients with complex heart diseases, like Shone’s syndrome. A thorough understanding of the impact of pregnancy on the haemodynamic response to the patient’s cardiac lesion is required for the management of labour and delivery. A meticulous approach is needed when planning anaesthesia for Caesarean section in such a case as the associated haemodynamic effects of both regional and general anaesthesia can have a serious deleterious effect on both the mother and infant. We report on the successful management of a parturient known to have Shone's syndrome undergoing Caesarean section under graded epidural anaesthesia.