Perioperative Management of Parturient Women With Severe Pulmonary Arterial Hypertension Secondary to Atrial Septal Defect

At our institution, we occasionally see pregnant patients in the later stages of pregnancy who present with severe pulmonary arterial hypertension caused by congenital heart disease. The physiological changes in pregnancy may worsen the cardiovascular status leading to heart failure which is associated with a high incidence of morbidity and mortality. A scheduled caesarean section in such patients ensures delivery in a controlled environment, avoiding prolonged labour, which is detrimental. Perioperative complications that may worsen pulmonary arterial hypertension should be prevented. The perioperative management, in particular, the anaesthesia technique used and the clinical outcome of this population, is discussed through five interesting cases. Despite a multidisciplinary team and intensive care management, two patients with existing cor pulmonale, one of whom received general and the other central neural blockade anaesthesia, succumbed to their illness immediately after lower segment caesarean section. The management of severe pulmonary arterial hypertension in pregnant patients remains a multidisciplinary challenge among participating physicians. Thorough perioperative preparation encompassing monitoring, medical therapy, timing and mode of delivery, and risk consultation is vital in avoiding circumstances that could exacerbate pulmonary arterial hypertension, with physicians readily equipped to promptly detect and manage any untoward event.