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Peripartum cardiomyopathy and thromboembolism; anesthetic management and clinical course of an obese, diabetic patient

[Cardiopathie périnatale et thromboembolie ; prise en charge anesthésique adoptée et évolution clinique d’une patiente diabétique et obèse]

Ian Kaufman, MD^*, Richard Bondy, MD^* and Alice Benjamin, MD

^* From the Department of Anesthesia, and
the Department of Obstetrics & Gynecology McGill University Health Centre Royal Victoria Hospital Montreal Quebec Canada.

Address correspondence to: Dr. Ian Kaufman, Royal Victoria Hospital, 687 Pine Avenue West, Montreal, Quebec H3A 1A1, Canada. Phone: 514-842-1231, ext. 34880; Fax: 514-843-1723; E-mail: iankaufman{at}hotmail.com

Purpose: To describe the anesthetic management and clinical course of a patient with peripartum cardiomyopathy. We highlight the frequent occurrence of thromboembolic morbidity in this group of parturients, emphasizing the need for early consideration of prophylactic anticoagulation.

Clinical features: A 38-yr-old, diabetic, obese parturient was admitted with pulmonary edema and severe orthopnea at 31 weeks gestation. The respiratory rate was 44 breaths•min^-1, blood pressure 110/70 mmHg, pulse 120 beats•min^-1 and rales were heard in both lung fields. The diagnosis of peripartum cardiomyopathy was made based on sinus tachycardia with no evidence of ischemia on the electrocardiogram, and global left ventricular hypokinesis with an ejection fraction of 40–45% noted on transthoracic echocardiography. Cesarean delivery was planned to improve maternal respiratory status and hemodynamics. General anesthesia with invasive monitoring was planned, and surgery and anesthesia proceeded uneventfully. Less than 24 hr postoperatively, she sustained a thrombotic cerebral infarct leaving her hemiparetic and dysarthric. Subsequent investigations revealed a thrombophilic state due to elevated anticardiolipin antibody.

Conclusion: General anesthesia is an acceptable option in parturients with heart failure secondary to cardiomyopathy. Thromboembolic complications are common, and early consideration should be given to prophylactic anticoagulation.

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