Peripartum anesthetic management in patients with left ventricular noncompaction: a case series and review of the literature

•Noncompaction predisposes to arrhythmias, hemodynamic instability and heart failure.•Sequential combined spinal-epidural anesthesia is ideal for these parturients.•Coordination is key to managing noncompaction patients during labor and delivery. This retrospective review focuses on peripartum anest...

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Bibliographic Details
Published in:International journal of obstetric anesthesia 2022-11, Vol.52, p.103575-103575, Article 103575
Main Authors: Clark, K.J., Arendt, K.W., Rehfeldt, K.H., Sviggum, H.P., Kauss, M.L., Ammash, N.M., Rose, C.H., Sharpe, E.E.
Format: Article
Language:English
Subjects:
Arrhythmia
Heart failure
Hypertrabeculation
Left ventricular noncompaction
Pregnancy
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Summary:•Noncompaction predisposes to arrhythmias, hemodynamic instability and heart failure.•Sequential combined spinal-epidural anesthesia is ideal for these parturients.•Coordination is key to managing noncompaction patients during labor and delivery. This retrospective review focuses on peripartum anesthetic management and outcome of a series of five pregnant women with left ventricular noncompaction (LVNC). The Mayo Clinic Advanced Cohort Explorer medical database was utilized to identify women diagnosed with LVNC who had been admitted for delivery at the Mayo Clinic in Rochester, Minnesota, between January 2001 and September 2021. Echocardiograms were independently reviewed by two board-certified echocardiographers, and those determined by both to meet the Jenni criteria and/or having compatible findings on magnetic resonance imaging (MRI) were included. Electronic medical records were reviewed for information pertaining to cardiac function, labor, delivery, and postpartum management. We identified 44 patients whose medical record included the term “noncompaction” or “hypertrabeculation” and who had delivered at our institution during the study period. Upon detailed review of the medical records, 36 did not meet criteria for LVNC, and three additional patients did not receive the diagnosis until after delivery, leaving five patients with confirmed LVNC who had undergone six deliveries during the study interval. All five patients had a history of arrhythmias or had developed arrhythmias during pregnancy. One patient underwent emergency cesarean delivery due to sustained ventricular tachycardia requiring three intra-operative cardioversions. This case series adds new evidence to that already available about pregnancies among women with LVNC. Favorable obstetrical outcomes were achievable when multidisciplinary teams were prepared to manage the maternal and fetal consequences of intrapartum cardiac arrhythmias and hemodynamic instability.
ISSN:0959-289X
1532-3374
DOI:10.1016/j.ijoa.2022.103575