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  • Print publication year: 2008
  • Online publication date: October 2009

1 - Structural heart disease in pregnant women

from Section 1 - Cardiovascular and respiratory disorders
    • By Brendan Carvalho, Department of Anesthesia, Stanford University School of Medicine, Stanford, CA, USA, Ethan Jackson, Clinical Assistant Professor of Cardiothoracic Anesthesia; Director of Intraoperative Transesophageal Echocardiography; Division Chief of Adult Congenital Cardiothoracic Anesthesia, Stanford University, Medical Center, Lucille Packard Children's Hospital Stanford, CA, USA
  • Edited by David R. Gambling, University of California, San Diego, M. Joanne Douglas, University of British Columbia, Vancouver, Robert S. F. McKay, University of Kansas
  • Publisher: Cambridge University Press
  • DOI:
  • pp 1-28



This chapter will outline the physiological changes, hemodynamic goals, management, and anesthetic options with regards to patients with acquired or congenital structural heart disease during pregnancy, labor, and delivery. There is no consensus as to the optimal anesthetic technique for the conditions being discussed. General and regional anesthesia can have significant cardiovascular effects on a parturient with cardiac disease. In addition, many pharmacological agents commonly used in anesthetic and obstetric practice can have adverse hemodynamic effects (Table 1.1).

Due to the nature and the rarity of the cardiac diseases discussed, there is a lack of randomized controlled studies to guide our practice. As a result, case reports and expert opinion will form the basis of discussing the anesthetic techniques. However, management options and anesthetic techniques must be individualized and based on the prevailing hemodynamic condition and obstetric needs.

Scope of the problem

An estimated 0.2–3.0% of pregnant patients have cardiac disease, an increasing cause of maternal mortality. The 2000– 2 Confidential Enquiries into Maternal Deaths in the United Kingdom reported that cardiac disease was the second most common nonobstetric cause of maternal death after psychiatric disease. Cardiac disease is also more common than the leading direct causes of maternal death. The maternal mortality rate ranges from 0.4% in New York Heart Association (NYHA) class I–II women to 6.8% in class III–IV (Tables 1.2 and 1.3).

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