Anaesthesia management of pregnant patient with uncorrected middle aortic syndrome (MAS) for caesarean section

Middle aortic syndrome is a rare congenital disease which involves segmental or diffuse narrowing of the abdominal and/or distal descending thoracic aorta. It may remain largely undetected in childhood and can present itself as gestational hypertension during pregnancy. Upper extremity hypertension is difficult to control during pregnancy. Excessive blood pressure lowering may result in hypotension distal to the obstruction and uterine hypoperfusion.It offers considerable challenge to Anaesthesiologist regarding choice of anaesthesia – Regional verses General Anaesthesia. Both having its own advantages and disadvantages in such patient.We describe a 29 years, primigravida with Middle aortic syndrome, diagnosed during first trimester. Patient was admitted with severe hypertension in upper extremity at 39 weeks. Caesarean delivery was carried out under General Anaesthesia. During perioperative period, Intravenous Nitroglycerine and Labetalol were used to maintain hemodynamic stability. Patient was shifted to ICU on ventilator. She had uneventful course in ICU and recovery was good.Pregnant Patient with uncorrected Middle aortic syndrome for Caesarean Section require suitable anaesthesia technique along with good blood pressure management leading to early recovery and reduction in complications.
 

Keywords: Middle, Aortic, Syndrome, Coarctation, Aorta, Caesarean, Section.