Graded Epidural Anaesthesia with Low-Dose Phenylephrine Infusion for Management of Caesarean Section Complicated with Severe Mitral Stenosis: A Case Report

A pregnant patient with a heart condition poses a unique challenge for the obstetrician and anaesthesiologist. Understanding the physiology of pregnancy and the pathophysiology of primary heart disease is important when providing anaesthesia for these high risk patients during childbirth. A 32-year-old primigravida at 35 weeks and two days of gestation was diagnosed with Rheumatic Heart Disease (RHD), severe Mitral Stenosis (MS), moderate Mitral Regurgitation (MR), mild Atrial Regurgitation (AR), moderate Tricuspid Regurgitation (TR), Pulmonary Arterial Hypertension (PAH), Atrial Fibrillation (AF), and Grade-II New York Heart Association (NYHA). The patient underwent an Elective Lower Segment Cesarean Section (LSCS) performed under epidural anaesthesia, and complications were satisfactorily managed.