Introduction: Pulmonary hypertension in combination with pregnancy can result in high maternal mortality. Mitral stenosis is one of the heart diseases that can complicate pregnancy. In this report, we describe the management of a pregnant patient with mitral stenosis and pulmonary hypertension.

Case report: A 25year old primigravida with mital stenosis and history of balloon mitral valvotomy 4 years back presented to our hospital. Echocardiography showed severe mitral stenosis and severe pulmonary hypertension with mitral valve area 1square centimetre. Cardiology and anaesthesia consultations were done and as per advice, balloon mitral valvotomy was done. Repeat echocardiography showed mild mitral stenosis and no pulmonary hypertension with mitral valve area 2.5square centimetre. After four days, caesarean section was done under general anaesthesia. Monitored with pulse oximetry, non-invasive blood pressure, ecg, capnography, urine output. Rapid sequence induction with thiopentone sodium and succinyl choline was done. Intubated, maintained under intermittent positive pressure ventilation with oxygen and nitrous oxide. Muscle relaxation maintained with vecuronium. After the delivery of a healthy baby, oxytocin, midazolam and fentanyl administered. Intra operative period uneventful. Reversed with neostigmine and glycopyrrolate and extubated when reversal was adequate. Shifted to post anaesthesia care unit when vitals were stable. Postoperative analgesia obtained with pethidine.

Conclusion: Patients with significant valvular heart disease require careful preoperative, multidisciplinary assessment and anaesthetic planning before delivery in order to optimize cardiac function during peripartum period.