Samalavicius R S, Puodziukaite L, Radaviciute I, Norkiene I, Urbonas K, Misiuriene I, Janusauskas V, Zorinas A, Rucinskas K, Serpytis P
Center for Anesthesia, Intensive Care, and Pain Management, Vilnius University Hospital Santariskiu Klinikos, Santariskiu Street 2, Vilnius, Lithuania.
Vilnius University, Faculty of Medicine, Universiteto Street 3, Vilnius, Lithuania.
Int J Obstet Anesth. 2018 Feb;33:67-71. doi: 10.1016/j.ijoa.2017.07.004. Epub 2017 Jul 14.
The use of intra-aortic balloon counter-pulsation for circulatory support in pregnant women with cardiac failure is limited to several case reports. Few publications have addressed the use of intra-aortic balloon counter-pulsation during delivery. We report a case using prophylactic intra-aortic balloon counter-pulsation during the management of a cesarean delivery in a patient with peripartum cardiomyopathy. A 28-year-old primigravid female at 37weeks of gestation was admitted with signs of worsening heart failure, and transthoracic echocardiography revealed a decreased left ventricular ejection fraction of 25%. A plan to proceed with cesarean delivery, using hemodynamic support with intra-aortic balloon counter-pulsation, was made during a multidisciplinary meeting. Shortly after initiation of intra-aortic balloon counter-pulsation, the patient's hemodynamics improved, with a decrease in heart rate and an increase in mean arterial blood pressure. After uneventful cesarean delivery of a healthy 3.2kg infant, the patient was transferred to intensive care and was extubated three hours later. Due to hemodynamic instability, intra-aortic balloon counter-pulsation support and vasopressor infusion were maintained for four postoperative days. The patient was discharged from the hospital on diuretics and beta-blocker treatment after 20days. Heart failure persisted, requiring heart transplantation 25months later. This report highlights the role of a multidisciplinary team approach in the management of delivery in an obstetric patient with peripartum cardiomyopathy.
