Abstract

BALVERDE FAZZIO, Mario. Manejo anestesiológico de las pacientes embarazadas portadoras de valvulopatía mitral: Trabajo de parto y cesárea. Anest Analg Reanim [online]. 2000, vol.16, n.1, pp.28-33. ISSN 1688-1273.

During pregnancy, mitral valve illness deteriorates the cardiovascular function. This subject becomes thus relevant, despite the low frequency of these cases. Although anaesthesia management will depend on given obstetric plans, there are general principles that have to be kept in mind in these patients with increased cardiovascular risk, in order to preserve vital functions in the mother as well as in the fetus. Among these are: to maintain normovolemic conditions, avoiding acute increase of volemia, to control heart rate at normal rates, to avoid pain during labor and/or caesarian section, to supply oxygen and finally to avoid aortocaval compression. Patients with structural valvular damage should receive prophylactic antibiotic therapy to prevent bacterial subacute endocarditis. Continuous electrocardiogram (ECG), non invasive arterial pressure, pulse oxymetry and diuresis should be routinely monitored in asymptomatic or low valvulopathy patients. In patients with moderate simtomatology, central venous or arterial measurement with central venous pressure (PVC) may be added. In severe cases cardiac output and capillary pulmonary arterial pressure should be measured by insertion of a Swan Ganz catheter. As pain is avoided, cardiovascular estrés is diminished, promoting the rapid recovery of the patient An ideal anesthetic technique cannot be recommended. For its choice, obstetric opportunity, valvular condition, preference of the anesthesiologist and the patient, etc. have to be considered. At present, regional techniques are being preferred in our environment but it should be estrésed and there is no ideal procedure and its choice depends on multiple aspects. In this review, the most commonly found valvular pathologies (stenosis, insufficiency and prolapse of the mitral valve) and the management of anestehesia before, during and in the postoperation period, will be described for labor as well as for cesarean section

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