Anesthetic Management of Hypertrophic Obstructive Cardiac Disease in Pregnancy

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Authors:

Cesar Padilla, MD, Brigham and Women’s Hospital, Boston, MA

Antonio Hernandez Conte, MD, MBA, Kaiser Permanente Los Angeles Medical Center, Los Angeles, CA

This PBLD was peer-reviewed by a panel of experts from the Society of Obstetric Anesthesia and Perinatology (SOAP) and has been endorsed by the SOAP Education Committee.

Learners should identify a faculty mentor and walk through the case together, after perusing the pre-course work. Tweet your comments and questions using the buttons provided in each question, and experts will weigh in.

Required pre-work: Reading list

1. Stergiopoulos, K., Shiang, E., & Bench, T. (2011). Pregnancy in patients with pre-existing cardiomyopathies. J Am Coll Cardiol, 58(4), 337-350. doi:10.1016/j.jacc.2011.04.014
2. Fernandes, S. M., Arendt, K. W., Landzberg, M. J., Economy, K. E., & Khairy, P. (2010). Pregnant women with congenital heart disease: cardiac, anesthetic and obstetrical implications. Expert Rev Cardiovasc Ther, 8(3), 439-448. doi:10.1586/erc.09.179
3. Hall, M. E., George, E. M., & Granger, J. P. (2011). [The heart during pregnancy]. Rev Esp Cardiol, 64(11), 1045-1050. doi:10.1016/j.recesp.2011.07.009

Learning Objectives

At the conclusion of the session, the fellow will be able to:

1. Discuss perioperative anesthetic management of the parturient with hypertrophic obstructive cardiomyopathy (HOCM).
2. Discuss basic transthoracic echocardiographic (TTE) views for evaluating left heart function in patients with HOCM-associated left ventricular outlet tract (LVOT) obstruction.
3. Discuss cardiac physiologic changes in pregnancy and be able to identify cardiac changes with TTE.
4. Describe hemodynamic changes during pregnancy and immediately post-partum and their effect on HOCM physiology.

Instructions for Faculty Mentor

Before proceeding with the case, perform an assessment of your fellow’s prior review of the teaching materials and current understanding of the topic. Review key points of learning, clarify any questions, and identify areas for further investigation by the fellow.