Kelainan jantung kongenital dan sistem kardiovaskular terjadi pada 7 sampai 10 per 1.000 kelahiran hidup (0,7%–1,0%). Penyakit jantung kongenital adalah bentuk penyakit bawaan yang paling umum dan sekitar 30% dari semua kejadian penyakit bawaan. Cacat jantung kongenital yang paling sering terabaikan pada masa kanak-kanak adalah Atrial Septal Defect (ASD) sekundum. Resiko operasi non-jantung akan meningkat jika ditemukan gagal jantung, hipertensi pulmonal dan sianosis. Dilaporkan kasus primigravida berumur 33 tahun, dengan usia kehamilan 32–34 minggu yang menjalani seksio sesarea. Pada pemeriksaan fisik didapatkan nadi 100 x/menit (reguler), tekanan darah 115/74 mmHg, saturasi oksigen 90-94% dengan suplemen oksigen 10 L/menit, edema pada kedua tungkai, tekanan vena jugular (JVP) tidak meningkat. Hasil laboratorium dalam batas normal. Hasil echocardiografi menunjukkan adanya ASD sekundum (berdiameter 2–3 cm), bidirectional shunt dominan kanan ke kiri (sindroma Eisenmenger), regurgitasi trikuspid, hipertensi pulmonal berat dengan perkiraan tekanan sistolik ventrikel kanan 109 mmHg dan ejeksi sistolik ventrikel kiri 67%. Teknik anestesi yang digunakan adalah anestesi epidural. Dilakukan pemasangan kateter vena sentral untuk memantau tekanan vena sentral. Regimen epidural yang digunakan adalah bupivacaine plain 0,3% dan fentanyl 50 mcg total volume 15 ml dengan teknik titrasi. Selama seksio sesarea, tekanan darah stabil, detak jantung dan saturasi oksigen baik. Pasien dipantau di ruang pemulihan selama 1 jam dan kemudian dipindahkan ke ICU dan dipulangkan pada hari ke 10 pasca operasi. Kesimpulan, pasien dengan ASD dan hipertensi pulmonal yang menjalani seksio sesarea dapat dilakukan anestesi epidural dengan teknik titrasi.
Atrial Septal Defect with Severe Pulmonary Hypertension was Scheduled for Cesarean Section
Abstract
Congenital abnormalities of the heart and cardiovascular system occur in 7 to 10 per 1,000 of live births (0.7 - 1.0%). Congenital heart disease is the most common form of congenital diseases and amounted to approximately 30% of all incidents of congenital diseases. Congenital heart defects are most often neglected in childhood is secundum atrial septal defect (ASD). The risk for non-cardiac surgery would increase if found heart failure, pulmonary hypertension and cyanosis. A 33-years old primigravida, in labor at 32-34 weeks of gestation who underwent caesarean section under epidural anesthesia. On physical examination pulse was 100 x/min, blood pressure was 115/74 mmHg, oxygen saturation was 90-94% with oxygen supplement 10 L/min, bilateral pitting pedal edema was present. All the laboratory results within normal limits. 2D Echo results osteum secundum ASD (2-3 cm in diameter), bidirectional shunt dominan right to left shunt (Eisenmenger’s syndrome), Tricuspid Regurgitation, Severe Pulmonary Hypertension with an estimated right ventricle systolic pressure of 109 mmHg and left ventricle systolic ejection fraction of 67%. The anesthetic technique was epidural anesthesia. We performed central venous catheter to monitoring central venous pressure. The epidural regimens used were bupivacaine plain 0,3% and fentanyl 50 mcg total volume 15 ml with titration techniques. During cesarean section, patient was stable blood pressure, heart rate and oxygen saturation. Patient was monitored in recovery room for 1 hour and then transferred to ICU and discharged on 10th postoperative day. Conclusion, patients with ASD and severe pulmonary hipertention, we can perform epidural anesthesia with titration techniques.
Continuous epidural anesthesia with double catheters for cesarean section in a patient with severe pulmonary hypertension