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Severe aortic stenosis and subarachnoid hemorrhage: Anesthetic management of lethal combination.

Sharma R, Mehta Y, Sapra H - J Anaesthesiol Clin Pharmacol (2013)

Bottom Line: We recently managed a known patient of severe AS, who presented with aneurysmal SAH.Patient was planned for eurovascular intervention.With proper assessment and planning, patient was managed with favorable outcome despite the restrictions faced in the neurovascular intervention laboratory.

View Article: PubMed Central - PubMed

Affiliation: Department of Anaesthesia and Critical Care, Medanta-The Medicity, Gurgaon, Haryana, India.

ABSTRACT
Despite advances in various modalities of management, subarachnoid hemorrhage (SAH) continues to be associated with high mortality, which is further increased by associated comorbidities. Aortic stenosis (AS) is one such disease which can further complicate the course of SAH. We recently managed a known patient of severe AS, who presented with aneurysmal SAH. Patient was planned for eurovascular intervention. With proper assessment and planning, patient was managed with favorable outcome despite the restrictions faced in the neurovascular intervention laboratory.

No MeSH data available.


Related in: MedlinePlus

Noncontrast CT head showing subarachnoid hemorrhage(Fisher grade 2)
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Figure 1: Noncontrast CT head showing subarachnoid hemorrhage(Fisher grade 2)

Mentions: A 50-year-old female patient, a known case of severe AS, presented to us with complaints of acute onset severe headache with nausea and vomiting for 2 days. She had history of marked limitation of physical activities and shortness of breath even on mild routine activity. Clinically, she had no neurological deficit. Heart rate was 70/min and noninvasive blood pressure was 168/70 mmHg. On auscultation, she had a pansystolic murmur in aortic area. Computed tomography (CT) scan [Figure 1] and CT angiography [Figure 2] of head showed SAH (Fisher grade 2) with lobulated, saccular anterior communicating artery aneurysm. Electrocardiogram suggested left ventricular (LV) hypertrophy. Transthoracic echocardiography revealed stenotic, calcified, bicuspid aortic valve with area of 0.7 cm2, increased pressure gradient (PG) across aortic valve [Figure 3] (mean PG 45 mmHg and peak PG 74 mmHg), concentric LV hypertrophy and good LV systolic function. Complete blood count, liver function, renal function, and coagulation profile tests were normal except hypokalemia (2.9 mEq/L). In that clinical scenario, patient was planned for emergency neurovascular intervention. Patient was classified as American Society of Anesthesiologists IIIE and accepted for anesthesia and procedure with high-risk informed consent from the patient and relatives.


Severe aortic stenosis and subarachnoid hemorrhage: Anesthetic management of lethal combination.

Sharma R, Mehta Y, Sapra H - J Anaesthesiol Clin Pharmacol (2013)

Noncontrast CT head showing subarachnoid hemorrhage(Fisher grade 2)
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC3713681&req=5

Figure 1: Noncontrast CT head showing subarachnoid hemorrhage(Fisher grade 2)
Mentions: A 50-year-old female patient, a known case of severe AS, presented to us with complaints of acute onset severe headache with nausea and vomiting for 2 days. She had history of marked limitation of physical activities and shortness of breath even on mild routine activity. Clinically, she had no neurological deficit. Heart rate was 70/min and noninvasive blood pressure was 168/70 mmHg. On auscultation, she had a pansystolic murmur in aortic area. Computed tomography (CT) scan [Figure 1] and CT angiography [Figure 2] of head showed SAH (Fisher grade 2) with lobulated, saccular anterior communicating artery aneurysm. Electrocardiogram suggested left ventricular (LV) hypertrophy. Transthoracic echocardiography revealed stenotic, calcified, bicuspid aortic valve with area of 0.7 cm2, increased pressure gradient (PG) across aortic valve [Figure 3] (mean PG 45 mmHg and peak PG 74 mmHg), concentric LV hypertrophy and good LV systolic function. Complete blood count, liver function, renal function, and coagulation profile tests were normal except hypokalemia (2.9 mEq/L). In that clinical scenario, patient was planned for emergency neurovascular intervention. Patient was classified as American Society of Anesthesiologists IIIE and accepted for anesthesia and procedure with high-risk informed consent from the patient and relatives.

Bottom Line: We recently managed a known patient of severe AS, who presented with aneurysmal SAH.Patient was planned for eurovascular intervention.With proper assessment and planning, patient was managed with favorable outcome despite the restrictions faced in the neurovascular intervention laboratory.

View Article: PubMed Central - PubMed

Affiliation: Department of Anaesthesia and Critical Care, Medanta-The Medicity, Gurgaon, Haryana, India.

ABSTRACT
Despite advances in various modalities of management, subarachnoid hemorrhage (SAH) continues to be associated with high mortality, which is further increased by associated comorbidities. Aortic stenosis (AS) is one such disease which can further complicate the course of SAH. We recently managed a known patient of severe AS, who presented with aneurysmal SAH. Patient was planned for eurovascular intervention. With proper assessment and planning, patient was managed with favorable outcome despite the restrictions faced in the neurovascular intervention laboratory.

No MeSH data available.


Related in: MedlinePlus