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重度二尖瓣狭窄孕妇行球囊二尖瓣成形术的麻醉考量:一例病例报告及文献综述

Anaesthetic Considerations for Balloon Mitral Valvuloplasty in Pregnant Patient with Severe Mitral Stenosis: A Case Report and Review of Literature.

作者信息

Goyal Puneet, Tewari Satyendra, Chatterjee Arindam

机构信息

Assistant Professor, Department of Anaesthesiology, King George's Medical University, Lucknow, Uttar Pradesh, India.

Additional Professor, Department of Anaesthesiology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India.

出版信息

J Clin Diagn Res. 2017 Sep;11(9):UD01-UD03. doi: 10.7860/JCDR/2017/28379.10579. Epub 2017 Sep 1.

Abstract

Even though, the incidence of Mitral Stenosis (MS) has reduced grossly, it still remains a health problem in developing countries and is the most common rheumatic valvular lesion encountered in pregnant patients. The already compromised cardiac status of a pregnant female deteriorates further by the presence of MS. So, pregnancy is a common situation during which untreated and frequently poorly tolerated MS are first diagnosed. Percutaneous Balloon Mitral Valvuloplasty (BMV) may be life saving in such a setting and a multidisciplinary approach in the management reduces the mortality and morbidity during the procedure. Anaesthetic management of such a procedure has hardly ever been reported. We report a case of a 23-year-old woman presenting at 28 weeks gestation with severe MS and severe pulmonary hypertension (52 mmHg) who underwent successful percutaneous BMV under monitored anaesthesia Care. The anaesthetic considerations in such situations are being discussed.

摘要

尽管二尖瓣狭窄(MS)的发病率已大幅降低,但在发展中国家它仍是一个健康问题,并且是孕妇中最常见的风湿性瓣膜病变。怀孕女性原本就已受损的心脏状况会因MS的存在而进一步恶化。因此,怀孕是一种常见情况,在此期间,未经治疗且通常耐受性差的MS首次被诊断出来。在这种情况下,经皮球囊二尖瓣成形术(BMV)可能挽救生命,多学科管理方法可降低手术期间的死亡率和发病率。关于此类手术的麻醉管理几乎从未有过报道。我们报告一例23岁女性,妊娠28周时因严重MS和严重肺动脉高压(52 mmHg)就诊,在麻醉监测下成功接受了经皮BMV。本文讨论了此类情况下的麻醉注意事项。

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