Case Report: Anaesthetic Considerations for a Pregnant Patient with Rheumatic Heart Disease

Abstract

Managing cardiac disease during pregnancy presents unique challenges, particularly in women with valvular conditions such as rheumatic heart disease (RHD) and mitral valve prolapse (MVP). This case report discusses a 34-year-old multigravida at 37 weeks with severe mitral regurgitation and mild mitral stenosis secondary to RHD, who underwent an emergency caesarean section under spinal anaesthesia. The surgery proceeded without complications, and the patient was discharged in stable condition. RHD increases the risk of heart failure during pregnancy, necessitating a multidisciplinary approach involving obstetricians, cardiologists, and anaesthesiologists to minimise maternal and foetal risks. MVP, though often well-tolerated in pregnancy, can lead to serious complications in advanced cases, including arrhythmias and infective endocarditis. Prophylactic antibiotics and beta-blockers may be considered in high-risk patients. Neuraxial anaesthesia is commonly used in such cases, with phenylephrine preferred to maintain haemodynamic stability. This case highlights the importance of early diagnosis, tailored anaesthetic strategies, and collaborative care to optimise outcomes for both mother and foetus.