Anesthetic management of a patient with a transplanted heart undergoing a cesarean section: A case report

Background: This study was aimed to evaluate the outcomes of anesthetic management in a pregnant patient post orthotopic heart transplant secondary to dilated cardiomyopathy with severe left ventricular systolic function. Case Description: This is 25-year-old pregnant women, primigravida, gestational age at 34 weeks and 5 days that was electively admitted for further investigation in King Faisal Specialist Hospital and Research Center (KFSH&RC), Riyadh, Saudi Arabia, for multidisciplinary meeting, to properly optimize the patient status and approach the best possible outcome. The patient underwent orthotopic heart transplant in September 2011 due to dilated cardiomyopathy with severe left ventricular systolic dysfunction. The initial plan for this patient was pure neuraxial anesthesia, utilizing a Epidural and spinal combined anaesthesia. This, however, was complicated by an accidental dural puncture with an 18-gauge Tuohy needle, causing post dural puncture headache which was then later treated by an epidural blood patch. Conclusion: The perioperative management of such cases requires an intricate plan by an experienced team in a multidisciplinary approach to optimize intra and post operative outcomes for both mother and neonate. Keeping in mind all cardiac considerations of a transplanted heart and pregnancy, that normally involve the physiological, anatomical, and pharmacological changes and their role in the perioperative period. Anesthetic approach whether General anesthesia or neuroaxial anesthesia depends heavily on cardiac reserve and function.