Anesthetic Management of Cesarean Sections in Parturients with Valvular Heart Disease

Valvular heart disease during pregnancy and labor poses a significant threat to maternal and fetal outcomes, increasing morbidity. The physiological changes of pregnancy in a parturient with stenotic and regurgitant lesions increases the risk of cardiac decompensation. Moderate-to-severe stenotic lesions can deteriorate in pregnancy due to an increase in workload on the heart, leading to complications such as congestive heart failure, atrial fibrillation, and thromboembolism. Maintaining uteroplacental perfusion and systemic vascular resistance in a fixed output state is quite challenging during the perioperative period. There is no single best technique for the management of such patients for labor or cesarean section. A good understanding of the normal physiological changes with their impact on the pathophysiology and the severity of the lesion will help in successful perioperative management. We describe the anesthetic management of parturients with known valvular heart disease posted for emergencies as well as elective lower segment cesarean section.