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All Journal Indonesian Journal of Anesthesiology and Reanimation (IJAR)
Himawan, Muhammad Wildan Afif
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Medicine & Pharmacology

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Administration of Nitrates After Spontaneous Delivery in Rheumatic Heart Disease Koeshardiandi, Mirza; Himawan, Muhammad Wildan Afif; Perdhana, Fajar; Wicaksana, Zulfikar Loka
Indonesian Journal of Anesthesiology and Reanimation Vol. 5 No. 1 (2023): Indonesian Journal of Anesthesiology and Reanimation (IJAR)
Publisher : Faculty of Medicine-Universitas Airlangga

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.20473/ijar.V5I12023.45-50

Abstract

Introduction: Heart disease is one of the most common causes of maternal death. The incidence has increased since women with congenital and acquired heart disease reached fertile age. The circulation system changes during pregnancy which are induced by changes in the progesterone. The changes in progesterone levels increase heart work and cause death in pregnant women. Objective: This report aims to elaborate on the administration of nitrates as the management of labor in rheumatic heart disease (RHD). Case Report: A 27-year-old woman complained of shortness of breath and wanted to give birth. The patient was 38 weeks pregnant and had a history of heart disease. Antero-posterior chest radiography examination showed pulmonary edema and cardiomegaly. The patient was examined using echocardiography before spontaneous labor and was diagnosed as pregnant with rheumatic heart disease. As an emergency management, the patient was given painless spontaneous labor. The patient was given nitrates on the first day after delivery as a treatment for progesterone withdrawal syndrome in this case. After the delivery process was completed, the patient was admitted to the Intensive Care Unit (ICU). Progesterone hormone produced by the corpus luteum and the placenta until the eighth week of pregnancy and before delivery, respectively, can reduce systemic vascular resistance. Progesterone hormone increase causes peripheral vasodilation by affecting the function of endothelial nitric oxide synthase (eNOS) and nitrite oxide (NO) production. Conclusion: A pregnant woman with rheumatic heart disease can be given exogenous nitrate. Administration of exogenous nitrates in this patient successfully prevent the reduction of peripheral vascular resistance and postpartum hemodynamic instability because it can replace the reduction in nitric oxide caused by progesterone withdrawal.
Perioperative Management of Marfan Syndrome in Pregnancy and Congestive Heart Failure Koeshardiandi, Mirza; Mudianto, Fajar Tri; Himawan, Muhammad Wildan Afif; Abuajwa, Ahmed Eliaan Shaker; Semedi, Bambang Pujo
Indonesian Journal of Anesthesiology and Reanimation Vol. 6 No. 1 (2024): Indonesian Journal of Anesthesiology and Reanimation (IJAR)
Publisher : Faculty of Medicine-Universitas Airlangga

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.20473/ijar.V6I12024.42-49

Abstract

Introduction: A mutation in fibrillin-1 (FBN1) leads to the autosomal dominant condition known as Marfan Syndrome (MFS). The condition of pregnancy with MFS may increase morbidity and mortality during pregnancy and delivery. Due to a greater frequency of maternal problems and fetal involvement, pregnancy with Marfan syndrome (MFS) provides challenges to healthcare professionals and patients and requires special treatment. Objective: This study aimed to analyze the perioperative management of Marfan syndrome in pregnancy and congestive heart failure (CHF). Case report: A 27-year-old primigravida with 38-39 weeks gestation presented with a referral letter with a diagnosis of G1P0A0 with scoliosis and peripartum cardiomyopathy. The patient complained of shortness of breath accompanied by cold sweat since the second trimester of gestation. Physical examination revealed the presence of arachnodactyly and spine deformity. The patient underwent an emergency cesarean section with general anesthesia. Breathing problem appeared the next day after cesarean section, the patient was intubated in the ICU. Chest X-ray depicted bilateral pulmonary edema. A mechanical ventilator was set up and fluid restriction had been done. The patient was extubated after showing breathing improvement in the second week in the ICU. The diagnosis of MFS in this patient was defined based on the revised Ghent Nosology. MFS with spine deformity causes breathing problems because of the altered geometry of the thoracic cavity. MFS in pregnancy may worsen the breathing problem due to autotransfusion that leads to pulmonary edema. A mechanical ventilator with a specific setting accompanied by fluid restriction is recommended to reduce the fluid overload in the lungs. Conclusion: Mechanical ventilators with specific settings and fluid restriction are effective perioperative management to reduce pulmonary edema on MFS in pregnancy and congestive heart failure.
Co-Authors Abuajwa, Ahmed Eliaan Shaker Koeshardiandi, Mirza Mudianto, Fajar Tri Perdhana, Fajar Semedi, Bambang Pujo Wicaksana, Zulfikar Loka