Emergent Delivery In High Risk Parturient With Congenital Parachute Mitral Valve

Proposal Number:

MCC-7128 

Proposal Type:

Medically Challenging Case Report Poster 

Author:

Andy Peck  
University of Nebraska Medical Center

Co-Author(s):

Kelsie Cabrera  
University of Nebraska Medical Center
James Sullivan  
University of Nebraska Medical Center

Abstract:

A 20-year-old G1P0 female at 30 weeks gestation presented with shortness of breath, hemoptysis, and pulmonary edema. Past medical history included untreated congenital parachute mitral valve with severe mitral regurgitation and stenosis. Echocardiography on presentation demonstrated PASP of 110mmHg and mean mitral gradient of 35mmHg, which improved with diuretics and beta blockade. A multidisciplinary meeting was held shortly after admission to discuss plans for cardiac optimization and delivery. After several days, the patient's pulmonary status worsened, refractory tachycardia developed, and she was taken to the main OR. Preparations for possible VA-ECMO were made, followed by emergent cesarean delivery under general anesthesia. After delivery, the infant was intubated and taken to the NICU. The patient returned to the ICU intubated, and fluid shifts were monitored closely before weaning infusions and extubating. She transferred to the floor in good condition and was scheduled for future mitral valve repair.

Professional Category:

Resident/Trainee

Keywords:

Critical Care
Obstetric

Enter up to two references.

  Reference
1. Hakim F, Kendall C, Alharthi, M., Macina J, Jamil A, Mookadam F. Parachute mitral valve in adults – systematic overview. Echocardiography. 2010;27:581-6.
2. Tsiaras S, Poppas A. Mitral valve disease in pregnancy: outcomes and management. Obstet Med. 2009;2(1):6–10.