Anesthesia Management for Section Cesarean Delivery in Patient with Severe Mitral Stenosis

Fanniyah Fanniyah, Isngadi Isngadi


Background: Heart defects in pregnancy is one main nonobstetric factor causing morbidity and mortality in pregnant women. Mitral stenosis is common in pregnancy. The choice of anesthetic management has to consider hemodynamics, type of heart disease, and drugs used. Neuraxial anesthesia has been significantly used because it is considered safer than general anesthesia

Case: A 26-year-old woman with gestational age 32-34 weeks with severe mitral stenosis, moderate mitral regurgitation, severe tricuspid regurgitation, pulmonary hypertension, pericardial effusion, and atrial fibrillation underwent cesarean section with a low dose of spinal anesthesia using 5mg bupivacaine heavy 0.5% and Fentanyl 50 mcg. The sensory and motoric block was achieved in 5 minutes. Hemodynamic was stable during the perioperative phase. There was no heart failure or postoperative hemodynamic deterioration.

Conclusion: Low-dose spinal anesthesia using 5 mg of bupivacaine and fentanyl adjuvant can be used in cesarean section in patients with severe mitral stenosis due to rapid onset, adequate block level, stable hemodynamic, block duration, and healthy born babies.

Keywords: Pregnancy; mitral stenosis; C-section; neuraxial block; low dose


Pregnancy; mitral stenosis; C-section; neuraxial block; low dose

Full Text:



1. Isngadi I, Hartono R, Husodo DP, Prasedya ES. Low dose hyperbaric bupivacaine 5 mg combined with 50 mcg fentanyl for cesarean section in maternal heart disease. Anaesthesia, Pain & Intensive Care. 2019;274–8.

2. Isngadi I, Rafidya IS. Manajemen anestesi pada kehamilan dengan penyakit jantung. Malang: Departemen Anestesiologi dan Terapi Intensif FKUB RSUD Dr Saiful Anwar. 2017;78.

3. Hartono R, Isngadi I, Husodo DP. Anestesi Spinal Dosis Rendah Untuk Pasien Operasi Sesar dengan Stenosis Mitral Berat. JAI (Jurnal Anestesiologi Indonesia). 2018;10(3):163–74.

4. Nofiyanto E, Laksono RM, Isngadi I. Transversus Abdominis Plane Block sebagai Analgesia Post-operatif pada Pasien Sectio Caesarea dengan Stenosis Mitral Berat. Journal of Anaesthesia and Pain. 2020;1(2):38–43.

5. Sulistyawan V, Isngadi I, Laksono RM. Perbandingan Outcome Teknik Spinal Anestesi Dosis Rendah Dibandingkan Dosis Biasa pada Sectio Caesarea Darurat Di Rumah Sakit dr. Saiful Anwar. Journal of Anaesthesia and Pain. 2020;1(2):3–10.

6. Morgan GE, Mikhail MS. Morgan & Mikhail’s clinical anesthesiology. McGraw-Hill Education; 2018.

7. Hadzic A. Hadzic’s textbook of regional anesthesia and acute pain management. McGraw-Hill Education 2nd ed. New York, USA; 2017.


  • There are currently no refbacks.