Anesthetic management of cesarean section in a patient with Marfan's syndrome: a case report
Cheung, K.S.; Chan, K.C.; Chuah, E.C.; Tan, P.P.
Ma Zui Xue Za Zhi 31(3): 195-198
1993
ISSN/ISBN: 0254-1319 PMID: 7968343 Document Number: 6175
There is no doubt that the most appropriate maternal monitoring during cesarean delivery is by Swan-Ganz catheter at the time of cesarean section under epidural anesthesia. In our patient, we noticed a decrease in cardiac output and no change in the blood pressure throughout the procedure. The anesthesiologist administering general anesthesia to such a patient during cesarean section faces the challenge that the frequency of rupture parallels the physiologic increase in cardiac output and blood volume during pregnancy. Thus, hemodynamic alterations appear to be the most important predisposing factor that causes the rupture of the aneurysm. It is conjectured that there may be unrecognized active aortic root involvement prior to delivery which leads to dissection. The combination of aortic disease and pregnancy is potentially fatal. Strict medical surveillance of patient with Marfan's syndrome during pregnancy, including full invasive monitoring during delivery, may increase patient safety.
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