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1 - Structural heart disease in pregnant women

from Section 1 - Cardiovascular and respiratory disorders

Published online by Cambridge University Press:  19 October 2009

By
Brendan Carvalho  and
Ethan Jackson
Edited by
David R. Gambling ,
M. Joanne Douglas  and
Robert S. F. McKay
Brendan Carvalho
Affiliation:
Department of Anesthesia, Stanford University School of Medicine, Stanford, CA, USA
Ethan Jackson
Affiliation:
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
David R. Gambling
Affiliation:
University of California, San Diego
M. Joanne Douglas
Affiliation:
University of British Columbia, Vancouver
Robert S. F. McKay
Affiliation:
University of Kansas
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Summary

Introduction

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).

Type
Chapter
Information
Obstetric Anesthesia and Uncommon Disorders , pp. 1 - 28
Publisher: Cambridge University Press
Print publication year: 2008

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References

Kuczkowski, K. M.Labor analgesia for the parturient with cardiac disease: what does an obstetrician need to know?Acta Obstet. Gynecol. Scand. 2004; 83: 223–33.Google Scholar
Chang, J., Elam-Evans, L. D., Berg, C. J.et al. Pregnancy-related mortality surveillance – United States, 1991–1999. MMWR Surveill. Summ. 2003; 52: 1–8.Google Scholar
Cox, P. B. W., Gogarten, W. & Marcus, M. A. E.Maternal cardiac disease. Curr. Opin. Anesthesiol. 2005; 18: 257–62.Google Scholar
Confidential Enquiry into Maternal and Child Health. Why Mothers Die 2000–2002. The Sixth Report of the Confidential Enquiries into Maternal Death in the United Kingdom 2000–2002. London: RCOG Press, 2004.
McClure, J. & Cooper, G.Fifty years of confidential enquiries into maternal deaths in the United Kingdom: should anaesthesia celebrate or not?Int. J. Obstet. Anesth. 2005; 14: 87–9.Google Scholar
Thorne, S. A.Pregnancy in heart disease. Heart 2004; 90: 450–6.Google Scholar
Siu, S. C., Sermer, M., Colman, J. M.et al. Prospective multicenter study of pregnancy outcomes in women with heart disease. Circulation 2001; 104: 515–21.Google Scholar
Siu, S. C. & Colman, J. M.Heart disease and pregnancy. Heart 2001; 85: 710–5.Google Scholar
Ueland, K., Novy, M. J., Peterson, E. N. & Metcalfe, J.Maternal cardiovascular dynamics. IV. The influence of gestational age on the maternal cardiovascular response to posture and exercise. Am. J. Obstet. Gynecol. 1969; 104: 856–64.Google Scholar
Ueland, K. & Hansen, J. M.Maternal cardiovascular dynamics. 3. Labor and delivery under local and caudal analgesia. Am. J. Obstet. Gynecol. 1969; 103: 8–18.Google Scholar
Ueland, K. & Hansen, J. M.Maternal cardiovascular dynamics. II. Posture and uterine contractions. Am. J. Obstet. Gynecol. 1969; 103: 1–7.Google Scholar
Yeomans, E. R. & Gilstrap, L. C., 3rd. Physiologic changes in pregnancy and their impact on critical care. Crit. Care Med. 2005; 33: S256–8.Google Scholar
Expert consensus document on management of cardiovascular diseases during pregnancy. Eur. Heart J. 2003; 24: 761–81.
Ramin, S. M., Maberry, M. C. & Gilstrap, L. C., 3rd. Congenital heart disease. Clin. Obstet. Gynecol. 1989; 32: 41–7.Google Scholar
Presbitero, P., Somerville, J., Stone, S.et al. Pregnancy in cyanotic congenital heart disease. Outcome of mother and fetus. Circulation 1994; 89: 2673–6.Google Scholar
Pitkin, R. M., Perloff, J. K., Koos, B. J. & Beall, M. H.Pregnancy and congenital heart disease. Ann. Intern. Med. 1990; 112: 445–54.Google Scholar
Allan, L. D., Crawford, D. C., Chita, S. K.et al. Familial recurrence of congenital heart disease in a prospective series of mothers referred for fetal echocardiography. Am. J. Cardiol. 1986; 58: 334–7.Google Scholar
Dajani, A. S., Taubert, K. A., Wilson, W.et al. Prevention of bacterial endocarditis. Recommendations by the American Heart Association. Circulation 1997; 96: 358–66.Google Scholar
Born, D., Martinez, E. E., Almeida, P. A.et al. Pregnancy in patients with prosthetic heart valves: the effects of anticoagulation on mother, fetus, and neonate. Am. Heart J. 1992; 124: 413–7.Google Scholar
Wong, V., Cheng, C. H. & Chan, K. C.Fetal and neonatal outcome of exposure to anticoagulants during pregnancy. Am. J. Med. Genet. 1993; 45: 17–21.Google Scholar
Bonow, R. O., Carabello, B., Leon, A. C. Jr.et al. Guidelines for the management of patients with valvular heart disease: executive summary. A report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee on Management of Patients with Valvular Heart Disease). Circulation 1998; 98: 1949–84.Google Scholar
Ginsberg, J. S. & Hirsh, J.Use of antithrombotic agents during pregnancy. Chest 1995; 108: 305S–311S.Google Scholar
Toglia, M. R. & Weg, J. G.Venous thromboembolism during pregnancy. N. Engl. J. Med. 1996; 335: 108–14.Google Scholar
Horlocker, T. T., Wedel, D. J., Benzon, H.et al. Regional anesthesia in the anticoagulated patient: defining the risks (the second ASRA Consensus Conference on Neuraxial Anesthesia and Anticoagulation). Reg. Anesth. Pain Med. 2003; 28: 172–97.Google Scholar
Barbour, L. A. & Pickard, J.Controversies in thromboembolic disease during pregnancy: a critical review. Obstet. Gynecol. 1995; 86: 621–33.Google Scholar
Ramamurthy, S., Talwar, K. K., Saxena, A.et al. Prosthetic mitral valve thrombosis in pregnancy successfully treated with streptokinase. Am. Heart J. 1994; 127: 446–8.Google Scholar
Brian, J. E. Jr., Seifen, A. B., Clark, R. B.et al. Aortic stenosis, cesarean delivery, and epidural anesthesia. J. Clin. Anesth. 1993; 5: 154–7.Google Scholar
Douglas, M. J., Farquharson, D. F., Ross, P. L. & Renwick, J. E.Cardiovascular collapse following an overdose of prostaglandin F2 alpha: a case report. Can. J. Anaesth. 1989; 36: 466–9.Google Scholar
Fujitani, S. & Baldisseri, M. R.Hemodynamic assessment in a pregnant and peripartum patient. Crit. Care Med. 2005; 33: S354–61.Google Scholar
Sandham, J. D., Hull, R. D., Brant, R. F.et al. A randomized, controlled trial of the use of pulmonary-artery catheters in high-risk surgical patients. N. Engl. J. Med. 2003; 348: 5–14.Google Scholar
Domino, K. B., Bowdle, T. A., Posner, K. L.et al. Injuries and liability related to central vascular catheters: a closed claims analysis. Anesthesiology 2004; 100: 1411–18.Google Scholar
Cohen, W. R., Steinman, T., Patsner, B.et al. Acute myocardial infarction in a pregnant woman at term. JAMA 1983; 250: 2179–81.Google Scholar
Oron, G., Hirsch, R., Ben-Haroush, A.et al. Pregnancy outcome in women with heart disease undergoing induction of labour. Br. J. Obstet. Gynaecol. 2004; 111: 669–75.Google Scholar
Silversides, C. K., Colman, J. M., Sermer, M. & Siu, S. C.Cardiac risk in pregnant women with rheumatic mitral stenosis. Am. J. Cardiol. 2003; 91: 1382–5.Google Scholar
Bhatla, N., Lal, S., Behera, G.et al. Cardiac disease in pregnancy. Int. J. Gynaecol. Obstet. 2003; 82: 153–9.Google Scholar
Batson, M. A., Longmire, S. & Csontos, E.Alfentanil for urgent caesarean section in a patient with severe mitral stenosis and pulmonary hypertension. Can. J. Anaesth. 1990; 37: 685–8.Google Scholar
al Kasab, S. M., Sabag, T., al Zaibag, M.et al. Beta-adrenergic receptor blockade in the management of pregnant women with mitral stenosis. Am. J. Obstet. Gynecol. 1990; 163: 37–40.Google Scholar
Stephen, S. J.Changing patterns of mitral stenosis in childhood and pregnancy in Sri Lanka. J. Am. Coll. Cardiol. 1992; 19: 1276–84.Google Scholar
Martinez-Rios, M. A., Tovar, S., Luna, J. & Eid-Lidt, G.Percutaneous mitral commissurotomy. Cardiol. Rev. 1999; 7: 108–16.Google Scholar
Fawzy, M. E., Kinsara, A. J., Stefadouros, M.et al. Long-term outcome of mitral balloon valvotomy in pregnant women. J. Heart Valve Dis. 2001; 10: 153–7.Google Scholar
Salome, N., Dias, C. C., Ribeiro, J.et al. Balloon mitral valvuloplasty during pregnancy – our experience. Rev. Port. Cardiol. 2002; 21: 1437–44.Google Scholar
Deshpande, S.Epidural analgesia for term vaginal delivery after balloon valvotomy for mitral stenosis at 24 weeks gestation. Int. J. Obstet. Anesth. 1998; 7: 177–80.Google Scholar
Esteves, C. A., Ramos, A. I., Braga, S. L.et al. Effectiveness of percutaneous balloon mitral valvotomy during pregnancy. Am. J. Cardiol. 1991; 68: 930–4.Google Scholar
Pan, P. H. & D'Angelo, R.Anesthetic and analgesic management of mitral stenosis during pregnancy. Reg. Anesth. Pain Med. 2004; 29: 610–15.Google Scholar
Hemmings, G. T., Whalley, D. G., O'Connor, P. J.et al. Invasive monitoring and anaesthetic management of a parturient with mitral stenosis. Can. J. Anaesth. 1987; 34: 182–5.Google Scholar
Clark, S. L., Phelan, J. P., Greenspoon, J.et al. Labor and delivery in the presence of mitral stenosis: central hemodynamic observations. Am. J. Obstet. Gynecol. 1985; 152: 984–8.Google Scholar
Kee, W. D., Shen, J., Chiu, A. T.et al. Combined spinal-epidural analgesia in the management of labouring parturients with mitral stenosis. Anaesth. Intens. Care 1999; 27: 523–6.Google Scholar
Ziskind, Z., Etchin, A., Frenkel, Y.et al. Epidural anesthesia with the Trendelenburg position for cesarean section with or without a cardiac surgical procedure in patients with severe mitral stenosis: a hemodynamic study. J. Cardiothorac. Anesth. 1990; 4: 354–9.Google Scholar
Clark, S. L.Monitoring and anaesthetic management of parturients with mitral stenosis. Can. J. Anaesth. 1987; 34: 654.Google Scholar
Birincioglu, C. L., Kucuker, S. A., Yapar, E. G.et al. Perinatal mitral valve interventions: a report of 10 cases. Ann. Thorac. Surg. 1999; 67: 1312–14.Google Scholar
Easterling, T. R., Chadwick, H. S., Otto, C. M. & Benedetti, T. J.Aortic stenosis in pregnancy. Obstet. Gynecol. 1988; 72: 113–18.Google Scholar
Arias, F. & Pineda, J.Aortic stenosis and pregnancy. J. Reprod. Med. 1978; 20: 229–32.Google Scholar
Lao, T. T., Sermer, M., MaGee, L.et al. Congenital aortic stenosis and pregnancy – a reappraisal. Am. J. Obstet. Gynecol. 1993; 169: 540–5.Google Scholar
Hustead, S. T., Quick, A., Gibbs, H. R.et al. “Pseudo-critical” aortic stenosis during pregnancy: role for Doppler assessment of aortic valve area. Am. Heart J. 1989; 117: 1383–5.Google Scholar
Whitfield, A. & Holdcroft, A.Anaesthesia for caesarean section in patients with aortic stenosis: the case for general anaesthesia. Anaesthesia 1998; 53: 109–12.Google Scholar
McIvor, R. A.Percutaneous balloon aortic valvuloplasty during pregnancy. Int. J. Cardiol. 1991; 32: 1–3.Google Scholar
Myerson, S. G., Mitchell, A. R., Ormerod, O. J. & Banning, A. P.What is the role of balloon dilatation for severe aortic stenosis during pregnancy?J. Heart Valve Dis. 2005; 14: 147–50.Google Scholar
Colclough, G. W., Ackerman, W. E., 3rd, Walmsley, P. M. & Hessel, E. A.Epidural anesthesia for a parturient with critical aortic stenosis. J. Clin. Anesth. 1995; 7: 264–5.Google Scholar
Velde, M., Budts, W., Vandermeersch, E. & Spitz, B.Continuous spinal analgesia for labor pain in a parturient with aortic stenosis. Int. J. Obstet. Anesth. 2003; 12: 51–4.Google Scholar
Pittard, A. & Vucevic, M.Regional anaesthesia with a subarachnoid microcatheter for caesarean section in a parturient with aortic stenosis. Anaesthesia 1998; 53: 169–73.Google Scholar
Pitkanen, M., Rosenberg, P., Silvanto, M. & Tuominen, M.Haemodynamic changes during spinal anaesthesia with slow continuous infusion or single dose of plain bupivacaine. Acta. Anaesthesiol. Scand. 1992; 36: 526–9.Google Scholar
Goertz, A. W., Lindner, K. H., Schutz, W.et al. Influence of phenylephrine bolus administration on left ventricular filling dynamics in patients with coronary artery disease and patients with valvular aortic stenosis. Anesthesiology 1994; 81: 49–58.Google Scholar
Brighouse, D.Anaesthesia for caesarean section in patients with aortic stenosis: the case for regional anaesthesia. Anaesthesia 1998; 53: 107–9.Google Scholar
Redfern, N., Bower, S., Bullock, R. E. & Hull, C. J.Alfentanil for caesarean section complicated by severe aortic stenosis. A case report. Br. J. Anaesth. 1987; 59: 1309–12.Google Scholar
Orme, R. M., Grange, C. S., Ainsworth, Q. P. & Grebenik, C. R.General anaesthesia using remifentanil for caesarean section in parturients with critical aortic stenosis: a series of four cases. Int. J. Obstet. Anesth. 2004; 13: 183–7.Google Scholar
Ray, P., Murphy, G. J. & Shutt, L. E.Recognition and management of maternal cardiac disease in pregnancy. Br. J. Anaesth. 2004; 93: 428–39.Google Scholar
Lesniak-Sobelga, A., Tracz, W., KostKiewicz, M.et al. Clinical and echocardiographic assessment of pregnant women with valvular heart diseases – maternal and fetal outcome. Int. J. Cardiol. 2004; 94: 15–23.Google Scholar
Campbell, N., Rosaeg, O. P. & Chan, K. L.Anaesthetic management of a parturient with pulmonary stenosis and aortic incompetence for Caesarean section. Br. J. Anaesth. 2003; 90: 241–3.Google Scholar
Sharma, S. K., Gambling, D. R., Gajraj, N. M.et al. Anesthetic management of a parturient with mixed mitral valve disease and uncontrolled atrial fibrillation. Int. J. Obstet. Anesth. 1994; 3: 157–62.Google Scholar
Lynch, C., 3rd & Rizor, R. F.Anesthetic management and monitoring of a parturient with mitral and aortic valvular disease. Anesth. Analg. 1982; 61: 788–92.Google Scholar
Shin, Y. K. & King, J. C.Combined mitral and aortic stenosis in a parturient: epidural anesthesia for labor and delivery. Anesth. Analg. 1993; 76: 682–3.Google Scholar
Lee, C. N., Wu, C. C., Lin, P. Y.et al. Pregnancy following cardiac prosthetic valve replacement. Obstet. Gynecol. 1994; 83: 353–6.Google Scholar
Mangano, D. T. Anesthesia for the pregnant cardiac patient. In Hughes, S. C., Levinson, G. & Rosen, M. A. (eds.), Shnider and Levinson's Anesthesia for Obstetrics, 4th edn. Philadelphia: Lippincott Williams & Wilkins, 2001.
North, R. A., Sadler, L., Stewart, A. W.et al. Long-term survival and valve-related complications in young women with cardiac valve replacements. Circulation 1999; 99: 2669–76.Google Scholar
Lutz, D. J., Noller, K. L., Spittell, J. A. Jr.et al. Pregnancy and its complications following cardiac valve prostheses. Am. J. Obstet. Gynecol. 1978; 131: 460–8.Google Scholar
Ibarra-Perez, C., Arevalo-Toledo, N., Cadena, Alvarez-de O. & Noriega-Guerra, L.The course of pregnancy in patients with artificial heart valves. Am. J. Med. 1976; 61: 504–12.Google Scholar
Klein, L. L. & Galan, H. L.Cardiac disease in pregnancy. Obstet. Gynecol. Clin. North Am. 2004; 31: 429–59.Google Scholar
Hayek, E. & Griffin, B.Mitral valve prolapse: old beliefs yield to new knowledge. Cleve. Clin. J. Med. 2002; 69: 889–96.Google Scholar
Chia, Y. T., Yeoh, S. C., Lim, M. C.et al. Pregnancy outcome and mitral valve prolapse. Asia Oceania J. Obstet. Gynaecol. 1994; 20: 383–8.Google Scholar
Shapiro, E. P., Trimble, E. L., Robinson, J. C.et al. Safety of labor and delivery in women with mitral valve prolapse. Am. J. Cardiol. 1985; 56: 806–7.Google Scholar
Alcantara, L. G. & Marx, G. F.Cesarean section under epidural analgesia in a parturient with mitral valve prolapse. Anesth. Analg. 1987; 66: 902–3.Google Scholar
Whitehead, S. J., Berg, C. J. & Chang, J.Pregnancy-related mortality due to cardiomyopathy: United States, 1991–1997. Obstet. Gynecol. 2003; 102: 1326–31.Google Scholar
Berg, C. J., Chang, J., Callaghan, W. M. & Whitehead, S. J.Pregnancy-related mortality in the United States, 1991–1997. Obstet. Gynecol. 2003; 101: 289–96.Google Scholar
Pearson, G. D., Veille, J. C., Rahimtoola, S.et al. Peripartum cardiomyopathy: National Heart, Lung, and Blood Institute and Office of Rare Diseases (National Institutes of Health) workshop recommendations and review. JAMA 2000; 283: 1183–8.Google Scholar
Nwosu, E. C. & Burke, M. F.Cardiomyopathy of pregnancy. Br. J. Obstet. Gynaecol. 1993; 100: 1145–7.Google Scholar
Hibbard, J. U., Lindheimer, M. & Lang, R. M.A modified definition for peripartum cardiomyopathy and prognosis based on echocardiography. Obstet. Gynecol. 1999; 94: 311–16.Google Scholar
Tidswell, M.Peripartum cardiomyopathy. Crit. Care Clin. 2004; 20: 777–88, xi.Google Scholar
Murali, S. & Baldisseri, M. R.Peripartum cardiomyopathy. Crit. Care Med. 2005; 33: S340–6.Google Scholar
Manolio, T. A., Baughman, K. L., Rodeheffer, R.et al. Prevalence and etiology of idiopathic dilated cardiomyopathy (summary of a National Heart, Lung, and Blood Institute workshop). Am. J. Cardiol. 1992; 69: 1458–66.Google Scholar
Hoeven, K. H., Kitsis, R. N., Katz, S. D. & Factor, S. M.Peripartum versus idiopathic dilated cardiomyopathy in young women – a comparison of clinical, pathologic and prognostic features. Int. J. Cardiol. 1993; 40: 57–65.Google Scholar
Lee, W.Clinical management of gravid women with peripartum cardiomyopathy. Obstet. Gynecol. Clin. North Am. 1991; 18: 257–71.Google Scholar
Breen, T. W. & Janzen, J. A.Pulmonary hypertension and cardiomyopathy: anaesthetic management for caesarean section. Can. J. Anaesth. 1991; 38: 895–9.Google Scholar
James, P. R.A review of peripartum cardiomyopathy. Int. J. Clin. Pract. 2004; 58: 363–5.Google Scholar
Hale, T. W.Medications and Mother's Milk: A Manual of Lactational Pharmacology, 11th edn. Amarillo: Pharmasoft Medical Publishing, 2004.
Beus, E., Mook, W. N., Ramsay, G.et al. Peripartum cardiomyopathy: a condition intensivists should be aware of. Intensive Care Med. 2003; 29: 167–74.Google Scholar
Beards, S. C., Freebairn, R. C. & Lipman, J.Successful use of continuous veno-venous haemofiltration to treat profound fluid retention in severe peripartum cardiomyopathy. Anaesthesia 1993; 48: 1065–7.Google Scholar
Pijna, I. L. & Buchter, C.Heart failure in women. Cardiol. Rev. 2003; 11: 337–44.Google Scholar
Mehta, N. J., Mehta, R. N. & Khan, I. A.Peripartum cardiomyopathy: clinical and therapeutic aspects. Angiology 2001; 52: 759–62.Google Scholar
Midei, M. G., DeMent, S. H., Feldman, A. M.et al. Peripartum myocarditis and cardiomyopathy. Circulation 1990; 81: 922–8.Google Scholar
Bozkurt, B., Villaneuva, F. S., Holubkov, R.et al. Intravenous immune globulin in the therapy of peripartum cardiomyopathy. J. Am. Coll. Cardiol. 1999; 34: 177–80.Google Scholar
Sliwa, K., Skudicky, D., Candy, G.et al. The addition of pentoxifylline to conventional therapy improves outcome in patients with peripartum cardiomyopathy. Eur. J. Heart Fail. 2002; 4: 305–9.Google Scholar
Cosmai, E. M., Puzis, L., Tsai, H. M. & Lian, E. C.Thrombocytopenic purpura and cardiomyopathy in pregnancy reversed by combined plasma exchange and infusion. Eur. J. Haematol. 2002; 68: 239–42.Google Scholar
Aravot, D. J., Banner, N. R., Dhalla, N.et al. Heart transplantation for peripartum cardiomyopathy. Lancet 1987; 2: 1024.Google Scholar
Keogh, A., Macdonald, P., Spratt, P.et al. Outcome in peripartum cardiomyopathy after heart transplantation. J. Heart Lung Transplant. 1994; 13: 202–7.Google Scholar
Aziz, T. M., Burgess, M. I., Acladious, N. N.et al. Heart transplantation for peripartum cardiomyopathy: a report of three cases and a literature review. Cardiovasc. Surg. 1999; 7: 565–7.Google Scholar
Kreitmann, B., D'Ercole, C., Yao, J. G.et al. Successful pregnancy 5 years after cardiac transplantation for peripartum cardiomyopathy. Transplant. Proc. 1997; 29: 2457.Google Scholar
Gambling, D. R., Flanagan, M. L., Huckell, V. F.et al. Anaesthetic management and non-invasive monitoring for caesarean section in a patient with cardiomyopathy. Can. J. Anaesth. 1987; 34: 505–8.Google Scholar
George, L. M., Gatt, S. P. & Lowe, S.Peripartum cardiomyopathy: four case histories and a commentary on anaesthetic management. Anaesth. Intens. Care 1997; 25: 292–6.Google Scholar
Velickovic, I. A. & Leicht, C. H.Continuous spinal anesthesia for cesarean section in a parturient with severe recurrent peripartum cardiomyopathy. Int. J. Obstet. Anesth. 2004; 13: 40–3.Google Scholar
McIndoe, A. K., Hammond, E. J. & Babington, P. C.Peripartum cardiomyopathy presenting as a cardiac arrest at induction of anaesthesia for emergency caesarean section. Br. J. Anaesth. 1995; 75: 97–101.Google Scholar
Lampert, M. B., Weinert, L., Hibbard, J.et al. Contractile reserve in patients with peripartum cardiomyopathy and recovered left ventricular function. Am. J. Obstet. Gynecol. 1997; 176: 189–95.Google Scholar
Chapa, J. B., Heiberger, H. B., Weinert, L.et al. Prognostic value of echocardiography in peripartum cardiomyopathy. Obstet. Gynecol. 2005; 105: 1303–8.Google Scholar
Sutton, M. S., Cole, P., Plappert, M.et al. Effects of subsequent pregnancy on left ventricular function in peripartum cardiomyopathy. Am. Heart J. 1991; 121: 1776–8.Google Scholar
Shah, D. M. & Sunderji, S. G.Hypertrophic cardiomyopathy and pregnancy: report of a maternal mortality and review of literature. Obstet. Gynecol. Surv. 1985; 40: 444–8.Google Scholar
Fairley, C. J. & Clarke, J. T.Use of esmolol in a parturient with hypertrophic obstructive cardiomyopathy. Br. J. Anaesth. 1995; 75: 801–4.Google Scholar
Pelliccia, F., Cianfrocca, C., Gaudio, C. & Reale, A.Sudden death during pregnancy in hypertrophic cardiomyopathy. Eur. Heart J. 1992; 13: 421–3.Google Scholar
Ducey, J. P. & Knape, K. G.Maternal esmolol administration resulting in fetal distress and cesarean section in a term pregnancy. Anesthesiology 1992; 77: 829–32.Google Scholar
Okutomi, T., Kikuchi, S., Amano, K.et al. Continuous spinal analgesia for labor and delivery in a parturient with hypertrophic obstructive cardiomyopathy. Acta Anaesthesiol. Scand. 2002; 46: 329–31.Google Scholar
Minnich, M. E., Quirk, J. G. & Clark, R. B.Epidural anesthesia for vaginal delivery in a patient with idiopathic hypertrophic subaortic stenosis. Anesthesiology 1987; 67: 590–2.Google Scholar
Ho, K. M., Kee, W. D. & Poon, M. C.Combined spinal and epidural anesthesia in a parturient with idiopathic hypertrophic subaortic stenosis. Anesthesiology 1997; 87: 168–9.Google Scholar
Loubser, P., Suh, K. & Cohen, S.Adverse effects of spinal anesthesia in a patient with idiopathic hypertrophic subaortic stenosis. Anesthesiology 1984; 60: 228–30.Google Scholar
Boccio, R. V., Chung, J. H. & Harrison, D. M.Anesthetic management of cesarean section in a patient with idiopathic hypertrophic subaortic stenosis. Anesthesiology 1986; 65: 663–5.Google Scholar
Autore, C., Brauneis, S., Apponi, F.et al. Epidural anesthesia for cesarean section in patients with hypertrophic cardiomyopathy: a report of three cases. Anesthesiology 1999; 90: 1205–7.Google Scholar
Tessler, M. J., Hudson, R., Naugler-Colville, M. & Biehl, D. R.Pulmonary oedema in two parturients with hypertrophic obstructive cardiomyopathy (HOCM). Can. J. Anaesth. 1990; 37: 469–73.Google Scholar
Katz, N. M., Collea, J. V., Moront, M. G.et al. Aortic dissection during pregnancy: treatment by emergency cesarean section immediately followed by operative repair of the aortic dissection. Am. J. Cardiol. 1984; 54: 699–701.Google Scholar
Kitchen, D. H.Dissecting aneurysm of the aorta in pregnancy. J. Obstet. Gynaecol. Br. Commonw. 1974; 81: 410–13.Google Scholar
Immer, F. F., Bansi, A. G., Immer-Bansi, A. S.et al. Aortic dissection in pregnancy: analysis of risk factors and outcome. Ann. Thorac. Surg. 2003; 76: 309–14.Google Scholar
Weiss, B. M., Segesser, L. K., Alon, E.et al. Outcome of cardiovascular surgery and pregnancy: a systematic review of the period 1984–1996. Am. J. Obstet. Gynecol. 1998; 179: 1643–53.Google Scholar
Zeebregts, C. J., Schepens, M. A., Hameeteman, T. M.et al. Acute aortic dissection complicating pregnancy. Ann. Thorac. Surg. 1997; 64: 1345–8.Google Scholar
Lipscomb, K. J., Smith, J. C., Clarke, B.et al. Outcome of pregnancy in women with Marfan's syndrome. Br. J. Obstet. Gynaecol. 1997; 104: 201–6.Google Scholar
Leyse, R., Ofstun, M., Dillard, D. H. & Merendino, K. A.Congenital aortic stenosis in pregnancy, corrected by extracorporeal circulation, offering a viable male infant at term but with anomalies eventuating in his death at four months of age – report of a case. JAMA 1961; 176: 1009–12.Google Scholar
Plunkett, M. D., Bond, L. M. & Geiss, D. M.Staged repair of acute type I aortic dissection and coarctation in pregnancy. Ann. Thorac. Surg. 2000; 69: 1945–7.Google Scholar
Rossouw, G. J., Knott-Craig, C. J., Barnard, P. M.et al. Intracardiac operation in seven pregnant women. Ann. Thorac. Surg. 1993; 55: 1172–4.Google Scholar
Salazar, E., Espinola, N., Molina, F. J.et al. Heart surgery with cardiopulmonary bypass in pregnant women. Arch. Cardiol. Mex. 2001; 71: 20–7.Google Scholar
Strickland, R. A., Oliver, W. C. Jr., Chantigian, R. C.et al. Anesthesia, cardiopulmonary bypass, and the pregnant patient. Mayo Clin. Proc. 1991; 66: 411–29.Google Scholar
Bernal, J. M. & Miralles, P. J.Cardiac surgery with cardiopulmonary bypass during pregnancy. Obstet. Gynecol. Surv. 1986; 41: 1–6.Google Scholar
Shah, A. M., Ikram, S., Kulatilake, E. N.et al. Emergency mitral valve replacement immediately following caesarean section. Eur. Heart J. 1992; 13: 847–9.Google Scholar
Lamarra, M., Azzu, A. A. & Kulatilake, E. N.Cardiopulmonary bypass in the early puerperium: possible new role for aprotinin. Ann. Thorac. Surg. 1992; 54: 361–3.Google Scholar
Ginz, B.Myocardial infarction in pregnancy. J. Obstet. Gynaecol. Br. Commonw. 1970; 77: 610–15.Google Scholar
Roth, A. & Elkayam, U.Acute myocardial infarction associated with pregnancy. Ann. Intern. Med. 1996; 125: 751–62.Google Scholar
Hankins, G. D., Wendel, G. D. Jr., Leveno, K. J. & Stoneham, J.Myocardial infarction during pregnancy: a review. Obstet. Gynecol. 1985; 65: 139–46.Google Scholar
Frenkel, Y., Etchin, A., Barkai, G.et al. Myocardial infarction during pregnancy: a case report. Cardiology 1991; 78: 363–8.Google Scholar
McLintic, A. J., Pringle, S. D., Lilley, S.et al. Electrocardiographic changes during cesarean section under regional anesthesia. Anesth. Analg. 1992; 74: 51–6.Google Scholar
Shivvers, S. A., Wians, F. H. Jr., Keffer, J. H. & Ramin, S. M.Maternal cardiac troponin I levels during normal labor and delivery. Am. J. Obstet. Gynecol. 1999; 180: 122.Google Scholar
Gibbons, R. J., Balady, G. J., Beasley, J. W.et al. ACC/AHA guidelines for exercise testing: executive summary. A report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee on Exercise Testing). Circulation 1997; 96: 345–54.Google Scholar
Elkayam, U. Pregnancy and cardiovascular disease. In Braunwald, E., Zipes, D. P. & Libby, P. (eds.), Heart Disease: A Textbook of Cardiovascular Medicine, 6th edn. Philadelphia: W.B. Saunders Company, 2001.
Sullebarger, J. T., Fontanet, H. L., Matar, F. A. & Singh, S. S.Percutaneous coronary intervention for myocardial infarction during pregnancy: a new trend?J. Invasive Cardiol. 2003; 15: 725–8.Google Scholar
Craig, S. & Ilton, M.Treatment of acute myocardial infarction in pregnancy with coronary artery balloon angioplasty and stenting. Aust. N. Z. J. Obstet. Gynaecol. 1999; 39: 194–6.Google Scholar
Eickman, F. M.Acute coronary artery angioplasty during pregnancy. Cathet. Cardiovasc. Diagn. 1996; 38: 369–72.Google Scholar
Parry, A. J. & Westaby, S.Cardiopulmonary bypass during pregnancy. Ann. Thorac. Surg. 1996; 61: 1865–9.Google Scholar
Schumacher, B., Belfort, M. A. & Card, R. J.Successful treatment of acute myocardial infarction during pregnancy with tissue plasminogen activator. Am. J. Obstet. Gynecol. 1997; 176: 716–19.Google Scholar
Pfeifer, G. W.The use of thrombolytic therapy in obstetrics and gynaecology. Australas. Ann. Med. 1970; 19: 28–31.Google Scholar
Hands, M. E., Johnson, M. D., Saltzman, D. H. & Rutherford, J. D.The cardiac, obstetric, and anesthetic management of pregnancy complicated by acute myocardial infarction. J. Clin. Anesth. 1990; 2: 258–68.Google Scholar
Secher, N. J., Arnsbo, P. & Wallin, L.Haemodynamic effects of oxytocin (syntocinon) and methyl ergometrine (methergin) on the systemic and pulmonary circulations of pregnant anaesthetized women. Acta Obstet. Gynecol. Scand. 1978; 57: 97–103.Google Scholar
Aglio, L. S. & Johnson, M. D.Anaesthetic management of myocardial infarction in a parturient. Br. J. Anaesth. 1990; 65: 258–61.Google Scholar
Findlow, D. & Doyle, E.Congenital heart disease in adults. Br. J. Anaesth. 1997; 78: 416–30.Google Scholar
Stayer, S. A., Andropoulos, D. B. & Russell, I. A.Anesthetic management of the adult patient with congenital heart disease. Anesthesiol. Clin. North America 2003; 21: 653–73.Google Scholar
Mendelson, M. A.Congenital cardiac disease and pregnancy. Clin. Perinatol. 1997; 24: 467–82.Google Scholar
Deanfield, J., Thaulow, E., Warnes, C.et al. Management of grown up congenital heart disease. Eur. Heart J. 2003; 24: 1035–84.Google Scholar
Burn, J., Brennan, P., Little, J.et al. Recurrence risks in offspring of adults with major heart defects: results from first cohort of British collaborative study. Lancet 1998; 351: 311–16.Google Scholar
Lovell, A. T.Anaesthetic implications of grown-up congenital heart disease. Br. J. Anaesth. 2004; 93: 129–39.Google Scholar
Zuber, M., Gautschi, N., Oechslin, E.et al. Outcome of pregnancy in women with congenital shunt lesions. Heart 1999; 81: 271–5.Google Scholar
Yuh, D. & Reitz, B. Left-to-right shunt defects. In Reitz, B. & Yuh, D. (eds.), Congenital Cardiac Surgery. San Francisco: McGraw-Hill, Inc., 2002.
Bent, S. Anesthesia for left-to-right shunt lesions. In Andropoulos, D., Stayer, S. & Russell, I. (eds.), Anesthesia for Congenital Heart Disease.Malden: Blackwell Futura Publishing, 2005.
Chia, P., Raman, S. & Tham, S. W.The pregnancy outcome of acyanotic heart disease. J. Obstet. Gynaecol. Res. 1998; 24: 267–73.Google Scholar
Rout, C. C.Anaesthesia and analgesia for the critically ill parturient. Best Pract. Res. Clin. Obstet. Gynaecol. 2001; 15: 507–22.Google Scholar
Patton, D. E., Lee, W., Cotton, D. B.et al. Cyanotic maternal heart disease in pregnancy. Obstet. Gynecol. Surv. 1990; 45: 594–600.Google Scholar
Burn, J.‘The next lady has a heart defect’. Br. J. Obstet. Gynaecol. 1987; 94: 97–9.Google Scholar
Baum, V. C.The adult patient with congenital heart disease. J. Cardiothorac. Vasc. Anesth. 1996; 10: 261–82.Google Scholar
Weiss, B. M. & Atanassoff, P. G.Cyanotic congenital heart disease and pregnancy: natural selection, pulmonary hypertension, and anesthesia. J. Clin. Anesth. 1993; 5: 332–41.Google Scholar
Veldtman, G. R., Connolly, H. M., Grogan, M.et al. Outcomes of pregnancy in women with Tetralogy of Fallot. J. Am. Coll. Cardiol. 2004; 44: 174–80.Google Scholar
Ramanathan, J., D'Alessio, J. G., Geller, E. et al. Analgesia and anesthesia during pregnancy. In Elkayam, U. & Gleicher, N. (eds.), Cardiac Problems in Pregnancy. Wiley-Liss, Inc., 1998.
Halpern, S., Gidwaney, A. & Gates, B.Anaesthesia for caesarean section in a pre-eclamptic patient with Ebstein's anomaly. Can. Anaesth. Soc. J. 1985; 32: 244–7.Google Scholar
Groves, E. R. & Groves, J. B.Epidural analgesia for labour in a patient with Ebstein's anomaly. Can. J. Anaesth. 1995; 42: 77–9.Google Scholar
Linter, S. P. & Clarke, K.Caesarean section under extradural analgesia in a patient with Ebstein's anomaly. Br. J. Anaesth. 1984; 56: 203–5.Google Scholar
Walker, E. & Malins, A. F.Anaesthetic management of aortic coarctation in pregnancy. Int. J. Obstet. Anesth. 2004; 13: 266–70.Google Scholar
Benny, P. S., Prasad, J. & Macvicar, J.Pregnancy and coarctation of the aorta. Case report. Br. J. Obstet. Gynaecol. 1980; 87: 1159–61.Google Scholar
Rosenthal, L.Coarctation of the aorta and pregnancy; report of five cases. Br. Med. J. 1955; 4904: 16–18.Google Scholar
Brickner, M. E., Hillis, L. D. & Lange, R. A.Congenital heart disease in adults. First of two parts. N. Engl. J. Med. 2000; 342: 256–63.Google Scholar
Brickner, M. E., Hillis, L. D. & Lange, R. A.Congenital heart disease in adults. Second of two parts. N. Engl. J. Med. 2000; 342: 334–42.Google Scholar
Schabel, J. E. & Jasiewicz, R. C.Anesthetic management of a pregnant patient with congenitally corrected transposition of the great arteries for labor and vaginal delivery. J. Clin. Anesth. 2001; 13: 517–20.Google Scholar
Yarrow, S. & Russell, R.Transposition of the great vessels: a series of three cases with a review of the literature. Int. J. Obstet. Anesth. 2000; 9: 179–85.Google Scholar
Fong, J., Druzin, M., Gimbel, A. A. & Fisher, J.Epidural anaesthesia for labour and caesarean section in a parturient with a single ventricle and transposition of the great arteries. Can. J. Anaesth. 1990; 37: 680–4.Google Scholar
Connolly, H. M., Grogan, M. & Warnes, C. A.Pregnancy among women with congenitally corrected transposition of great arteries. J. Am. Coll. Cardiol. 1999; 33: 1692–5.Google Scholar
Bosatra, M. G., Passarani, S., Marino, M. R.et al. Caesarean delivery of a patient with truncus arteriosus. Int. J. Obstet. Anesth. 1997; 6: 279–84.Google Scholar
Wilton, N. C., Traber, K. B. & Deschner, L. S.Anaesthetic management for caesarean section in a patient with uncorrected truncus arteriosus. Br. J. Anaesth. 1989; 62: 434–8.Google Scholar
Landau, R., Giraud, R., Morales, M.et al. Sequential combined spinal-epidural anesthesia for cesarean section in a woman with a double-outlet right ventricle. Acta Anaesthesiol. Scand. 2004; 48: 922–6.Google Scholar
Rowbottom, S. J., Gin, T. & Cheung, L. P.General anaesthesia for caesarean section in a patient with uncorrected complex cyanotic heart disease. Anaesth. Intensive Care 1994; 22: 74–8.Google Scholar
Atanassoff, P. G., Schmid, E. R., Jenni, R.et al. Epidural anesthesia for a cesarean section in a patient with pulmonary atresia and ventricular septal defect. J. Clin. Anesth. 1991; 3: 399–402.Google Scholar
Dob, D. P. & Yentis, S. M.UK registry of high-risk obstetric anaesthesia: report on cardiorespiratory disease. Int. J. Obstet. Anesth. 2001; 10: 267–72.Google Scholar
Ransom, D. M. & Leicht, C. H.Continuous spinal analgesia with sufentanil for labor and delivery in a parturient with severe pulmonary stenosis. Anesth. Analg. 1995; 80: 418–21.Google Scholar
Whittemore, R., Hobbins, J. C. & Engle, M. A.Pregnancy and its outcome in women with and without surgical treatment of congenital heart disease. Am. J. Cardiol. 1982; 50: 641–51.Google Scholar
Canobbio, M. M., Mair, D. D., Velde, M. & Koos, B. J.Pregnancy outcomes after the Fontan repair. J. Am. Coll. Cardiol. 1996; 28: 763–7.Google Scholar
Carp, H., Jayaram, A., Vadhera, R.et al. Epidural anesthesia for cesarean delivery and vaginal birth after maternal Fontan repair: report of two cases. Anesth. Analg. 1994; 78: 1190–2.Google Scholar
Cohen, A. M. & Mulvein, J.Obstetric anaesthetic management in a patient with the Fontan circulation. Br. J. Anaesth. 1994; 73: 252–5.Google Scholar
Grunwald, Z., Friedman, L., Hirsch, R. & Doron, K.Anesthetic management of labor and postpartum bleeding in a patient with Fontan physiology. Isr. J. Med. Sci. 1997; 33: 749–51.Google Scholar
Bonnin, M., Mercier, F. J., Sitbon, O.et al. Severe pulmonary hypertension during pregnancy: mode of delivery and anesthetic management of 15 consecutive cases. Anesthesiology 2005; 102: 1133–7.Google Scholar
Blaise, G., Langleben, D. & Hubert, B.Pulmonary arterial hypertension: pathophysiology and anesthetic approach. Anesthesiology 2003; 99: 1415–32.Google Scholar
Penning, S., Robinson, K. D., Major, C. A. & Garite, T. J.A comparison of echocardiography and pulmonary artery catheterization for evaluation of pulmonary artery pressures in pregnant patients with suspected pulmonary hypertension. Am. J. Obstet. Gynecol. 2001; 184: 1568–70.Google Scholar
Jones, A. M. & Howitt, G.Eisenmenger syndrome in pregnancy. Br. Med. J. 1965; 5451: 1627–31.Google Scholar
Avila, W. S., Grinberg, M., Snitcowsky, R.et al. Maternal and fetal outcome in pregnant women with Eisenmenger's syndrome. Eur. Heart. J. 1995; 16: 460–4.Google Scholar
Yentis, S. M., Steer, P. J. & Plaat, F.Eisenmenger's syndrome in pregnancy: maternal and fetal mortality in the 1990s. Br. J. Obstet. Gynaecol. 1998; 105: 921–2.Google Scholar
Geohas, C. & McLaughlin, V. V.Successful management of pregnancy in a patient with Eisenmenger syndrome with epoprostenol. Chest 2003; 124: 1170–3.Google Scholar
Goodwin, T. M., Gherman, R. B., Hameed, A. & Elkayam, U.Favorable response of Eisenmenger syndrome to inhaled nitric oxide during pregnancy. Am. J. Obstet. Gynecol. 1999; 180: 64–7.Google Scholar
Lacassie, H. J., Germain, A. M., Valdes, G.et al. Management of Eisenmenger syndrome in pregnancy with sildenafil and L-arginine. Obstet. Gynecol. 2004; 103: 1118–20.Google Scholar
Smedstad, K. G., Cramb, R. & Morison, D. H.Pulmonary hypertension and pregnancy: a series of eight cases. Can. J. Anaesth. 1994; 41: 502–12.Google Scholar
Martin, J. T., Tautz, T. J. & Antognini, J. F.Safety of regional anesthesia in Eisenmenger's syndrome. Reg. Anesth. Pain Med. 2002; 27: 509–13.Google Scholar
Ghai, B., Mohan, V., Khetarpal, M. & Malhotra, N.Epidural anesthesia for cesarean section in a patient with Eisenmenger's syndrome. Int. J. Obstet. Anesth. 2002; 11: 44–7.Google Scholar
Spinnato, J. A., Kraynack, B. J. & Cooper, M. W.Eisenmenger's syndrome in pregnancy: epidural anesthesia for elective cesarean section. N. Engl. J. Med. 1981; 304: 1215–17.Google Scholar
Asling, J. H. & Fung, D. L.Epidural anesthesia in Eisenmenger's syndrome: a case report. Anesth. Analg. 1974; 53: 965–8.Google Scholar
Cole, P. J., Cross, M. H. & Dresner, M.Incremental spinal anaesthesia for elective Caesarean section in a patient with Eisenmenger's syndrome. Br. J. Anaesth. 2001; 86: 723–6.Google Scholar
Filipovic, M., Seeberger, M. D., Schneider, M. C.et al. Transthoracic echocardiography for perioperative haemodynamic monitoring. Br. J. Anaesth. 2000; 84: 800–3.Google Scholar
Warnes, C. A.Pregnancy and pulmonary hypertension. Int. J. Cardiol. 2004; 97: 11–13.Google Scholar

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  • Structural heart disease in pregnant women
    • 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
  • Book: Obstetric Anesthesia and Uncommon Disorders
  • Online publication: 19 October 2009
  • Chapter DOI: https://doi.org/10.1017/CBO9780511544552.002
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  • Structural heart disease in pregnant women
    • 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
  • Book: Obstetric Anesthesia and Uncommon Disorders
  • Online publication: 19 October 2009
  • Chapter DOI: https://doi.org/10.1017/CBO9780511544552.002
Available formats
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  • Structural heart disease in pregnant women
    • 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
  • Book: Obstetric Anesthesia and Uncommon Disorders
  • Online publication: 19 October 2009
  • Chapter DOI: https://doi.org/10.1017/CBO9780511544552.002
Available formats
×