Peripartum kardiyomiyopatisi olan bir gebede epidural anestezi uygulamasi

Introduction: Peripartum cardiomyopathy (PPCM) is a rare but serious disorder in which initial left ventricular systolic dysfunction and symptoms of heart failure occur between the late stages of pregnancy and the early postpartum period of unknown etiology. The incidence of the disease varies between 1:1.300 and 1:15.000. Most common symptoms are chest pain, dyspnea, orthopnea, and peripheral edema. Recently, inclusion of echoeardiography has made diagnosis of PPCM easier and more accurate. We summarized a case of peripartum dilated eardiomyopathy presenting for caesarean section, which was successfully managed with epidural anesthesia. Case Report: A 34 years old parturient (253 weeks) who diagnosed as gestational hypertension as the blood pressure was 180/120 mmHg, and also presenting dyspnea, orthopnea, and peripheral edema was transferred to our hospital. At the arrival to our hospital, further examination and tests were applied to the patient; there was left bundle branch block, anteroseptal and inferior myoeardial infarction on ECG, pleural effusion on the right lung was seen on chest x-ray. Echocardiography had shown dilated eardiomyopathy, with an ejection fraction of 40%, a preponderance of right heart findings, and pulmonary hypertension. Epidural anesthesia was performed at L_4.5 interspace. 40 mg of 2 % lidocaine and 25 mg of 0.25% bupivacaine were injected into the epidural space. The patient's haemodynamic status was monitored with IBP at radial artery, ECG, pulse oximetry and central venous pressure. The block was adequate at T ₄ level and vital signs were stable. Patient's perioperative course was lasted one hour and was uneventful. She was discharged on 15^th day with medical therapy. Conclusion: In patients suffering from peripartum eardiomyopathy, undergoing caesarean section epidural anesthesia with invasive monitoring is an acceptable anesthetic alternative.