Segmental Spinal Anesthesia With Fascial Plane Block for Cesarean Delivery in Severe Mitral Stenosis: A Case Report

Severe mitral stenosis (MS) during pregnancy represents a fixed cardiac output state and poses major anesthetic challenges during elective cesarean delivery (CD). Conventional single-shot spinal anesthesia may precipitate profound hypotension in these patients. We report two high-risk parturients with severe MS, classified as New York Heart Association (NYHA) class III, who underwent elective CD. Both patients were managed using low-dose segmental spinal anesthesia supplemented with ultrasound-guided erector spinae plane block (ESPB) and invasive hemodynamic monitoring. In both cases, the procedures were completed with stable intraoperative hemodynamics and effective postoperative analgesia, without cardiopulmonary complications. The combination of segmental spinal anesthesia with regional fascial plane blocks and invasive monitoring may represent a viable alternative anesthetic strategy for elective CD in carefully selected parturients with severe MS.