Continuous epidural anesthesia with double catheters for cesarean section in a patient with severe pulmonary hypertension

Abstract Rationale: Pregnancy in a woman with pulmonary hypertension (PH) carries prohibitively high risks of cardiopulmonary complications and high maternal and fetal morbidity and mortality. Anaesthetic management during delivery or cesarean section is very important for the prognosis of pregnant women with PH. The choice between general anesthesia or intraspinal anesthesia is controversial. There have been few case reports of anesthetic management under continuous epidural anesthesia with double catheters in such patients. Patient concerns: A 35-year-old pregnant woman presented to the emergency department with fatigue and shortness of breath for 10 days at 16 weeks of gestation. Diagnosis: According to transthoracic echocardiogram, her pulmonary artery pressure (PAP) was 75 mm Hg, and she had a dilated left ventricle (67 mm) and a ventricular septal defect (1.7 mm) with a bidirectional shunt. Interventions: Elective cesarean section under continuous epidural anesthesia with double catheters to terminate a pregnancy in order to avoid development of cardiac failure. Outcomes: The pregnant woman underwent cesarean section safely and steadily under continuous epidural anesthesia with double catheters. She was discharged on the seventh postoperative day. Lessons: The advantages of continuous epidural anesthesia with double catheters are stable hemodynamics and complete analgesia. The continuous epidural anesthesia with double catheters can be applied to patients with cardiopulmonary disease like severe PH. Compared with general anesthesia, spinal anesthesia, and single-catheter epidural anesthesia continuous epidural anesthesia is a better option for patients with both PH and heart failure.