An Anesthetic Management of Takayasu Arteritis with Aortic Regurgitation in a Parturient Posted for Cesarean Section

Takayasu arteritis is an idiopathic, chronic, and inflammatory condition that mostly affects the aorta and its branches. Nearly 80% of occurrences involve females who are in their reproductive years. Although there is no effect on the disease's progression during pregnancy, these patients should be monitored for blood pressure (BP) changes and restricted intrauterine growth because they can develop complications such as hypertension, multiple organ dysfunction, and stenosis that reduces regional blood flow. Anesthetic implications of Takayasu arteritis include uncontrolled hypertension, maintenance of mean arterial pressure which is adequate to maintain end organ function, difficulty in monitoring of arterial pressure and tight maintenance of fluid regime.

A 31-year-old parturient, Gravida 3 Para 2 Living 0, hailing from north part of Karnataka, known hypertensive with previous lower segment cesarean section (LSCS) was a diagnosed case with Takayasu arteritis presented to us for elective LSCS. She had ahistory of two previous deaths of her neonate immediately following delivery. Moreover, on further evaluation was diagnosed with the above condition. Although a diagnosed case, she was never put on any treatment for the same. She was otherwise healthy carrying out her routine work without any discomfort. Her two-dimensional echo revealed severe aortic regurgitation. Rheumatology and CTVS opinion were taken. Cesarean section was planned under combined spinal epidural taking into account her clinical state and hemodynamics.

Pregnant women with Takayasu arteritis may experience an array of complications. Careful patient evaluation, treatment of TA and its complications, formulating anesthetic plan are fundamental. The key issue for these individuals is maintaining perfusion. Regional anesthesia is a safe anesthetic treatment that offers thorough preanesthetic examination and close monitoring of neurological status and BP for cesarean sections in pregnant women with Takayasu arteritis. Avoiding hemodynamic alterations and maintaining organ perfusion during the perioperative period are the most crucial objectives. To avoid postoperative complications, the patient should be monitored in an intensive care unit.