Anesthetic considerations in the critically Ill gravida with cardiac disease

Anesthetic management in the critically ill parturient is determined largely by the nature of the presenting illness. This chapter discusses many common and uncommon cardiac diseases that may affect parturients in detail, with a focus on peripartum anesthetic management. Congenital heart disease (CHD), with small left-to-right intracardiac shunt, account for 60-80 percent of cardiac diseases in pregnant patients in the United States. Rheumatic mitral valve stenosis is the acquired heart disease frequently encountered in the pregnant population. Mitral valve insufficiency or regurgitation is the second most common valvular disease observed in pregnancy. The occurrence of aortic stenosis (AS) in pregnancy is rare, yet significant, given that pregnancy is a high-risk period for patients with aortic pathology. Arrhythmias usually worsen during pregnancy, so patients with a preexisting atrial tachyarrhythmia should consider ablation prior to conceiving. Cardiac surgery during pregnancy is usually reserved only for severe symptomatic valvular or aortic pathologies, given its high morbidity and mortality.