MANAGEMENT OF PARTURIENT WITH NEW DIAGNOSIS OF CRITICAL AORTIC STENOSIS

Global Wound Care Congress

September 12-13, 2016 San Antonio, USA

Elizabeth McIntyre, Julie Kado and Michael Faulkner

Beaumont Health System, USA

Posters & Accepted Abstracts: J Nurs Care

Abstract :

Critical aortic stenosis (AS) is a rare and life-threatening complication in pregnancy. Tachycardia in pregnancy increases cardiac output while decreasing ventricular filling time, which is deleterious in AS. Physicians often recommend termination of pregnancy for the sake of maternal health. In this case, critical AS diagnosed at 17 weeks gestational age (GA) was treated with emergent replacement of the aortic valve at 21 weeks GA with survival of mother and fetus. A 35 year old multiparous female at 17 weeks GA with past medical history of gestational hypertension and hyperlipidemia presented emergently with dyspnea on exertion and newly diagnosed left bundle branch block. The patient was found to have critical AS and moderate aortic regurgitation by transthoracic echo. She was admitted to the cardiac intensive care unit for medical management until the fetus reached viability. At 21 weeks GA, the patient acutely decompensated, experiencing a 4 minute asystolic episode and receiving cardiopulmonary resuscitation. Multidisciplinary discussions led by the intensivist resulted in emergent coronary artery bypass grafting as well as an aortic valve replacement and aortic root endarterectomy with survival of mother and fetus. Multidisciplinary discussions organized and executed by the critical care intensivist are imperative for appropriate and timely treatment of AS in the parturient patient. In mild AS, parturients may be treated with medical therapy and expectant management until delivery, after which the valve can be surgically repaired. In more severe cases, symptomatic AS in pregnancy may be treated with balloon valvuloplasty. In this case, conservative management was first attempted. The parturient also did not qualify for balloon valvuloplasty or TAVR due to concurrent moderate to severe AR. However, acute decompensation in the patient�s cardiac status required emergent surgical intervention at 21 weeks GA. Intensivists managing parturients with severe symptomatic AS should consider surgical replacement and initiate multidisciplinary coordination between obstetricians and cardiothoracic surgeons.

Biography :

Email: liznrymcintyre@gmail.com