Epidural Anesthesia for Cesarean Section in Patients with Hypertrophic Cardiomyopathy

Abstract

HYPERTROPHIC cardiomyopathy (HCM) is a genetically transmitted cardiac disease with a broad clinical and morphologic spectrum that is now recognized with increasing frequency. 1 Although the dynamic characteristics of this disease are influenced by ventricular volume and vascular resistance, 2 pregnancy and delivery are usually well tolerated in patients with HCM, and only sporadic cases of maternal mortality have been reported. 3-5 In most cases, HCM patients had undergone vaginal delivery safely; however, cesarean section may be carried out for cardiac or obstetric indications. 3,6,7 Anesthetic management has not been determined in these cases, but epidural anesthesia is relatively contraindicated because of vasodilation and reduction in central blood volume. We report three consecutive patients with HCM who underwent cesarean section for cardiac indications, safely treated with epidural anesthesia.