CARDIOVASCULAR JOURNAL OF AFRICA • Vol 22, No 6, November/December 2011
AFRICA
337
coronary artery bypass graft surgery: a prospective, nested case-control
study.
J Am Coll Surg
2004;
198
(5): 742–747.
5.
Musleh GS, Patel NC, Grayson AD, Pullan AD, Keenan DJ, Fabri BM,
et al
. Off-pump coronary artery bypass surgery does not reduce gastro-
intestinal complications.
Eur J Cardiothorac Surg
2003;
23
: 170–174.
6.
Tenofsky PL, Beamer L, Smith RS. Ogilvie syndrome as a postopera-
tive complication.
Arch Surg
2000;
135
(6): 682–686.
7.
Ogilvie H. Large intestine colic due to sympathetic deprivation: a new
clinical syndrome.
Br Med J
1948;
2
: 671–367.
8.
De Giorgio R, Knowles CH. Acute colonic pseudo-obstruction
Br J
Surg
2009;
96
(3): 229–239.
9.
Meier C, Di Lazzaro M, Decurtins M. Ogilvie syndrome with cecal
perforation. A rare complication after isolated thoracic trauma. Case
report and current literature review.
Swiss Surg
2000;
6
(4): 184–191.
10. Zerr B, Fogliani J, Bouchet P. Treatment of colectasia occurring in
intensive care.
Ann Fr Anesth Reanim
1987;
6
(3): 159–162.
Anaesthesia for emergency Caesarean section in a
patient with peripartum cardiomypathy
BABATUNDE OSINAIKE, JOHNSON OGAH
Abstract
Peripartum cardiomyopathy (PPCM) is defined as the onset
of acute heart failure without demonstrable cause in the
last trimester of pregnancy or within the first six months
after delivery. We report a case of PPCM (LVEF
<
39%) in
a 30-year-old housekeeper requiring emergency Caesarean
section, who was successfully managed with combined
spinal–epidural anesthesia, using low-dose fentanyl for the
spinal anesthesia.
Keywords:
peripartum cardiomyopathy, combined spinal–
epidural anesthesia, Caesarean section
Submitted 17/5/10, accepted 19/8/10
Cardiovasc J Afr
2011;
22
: 337–340
DOI: 10.5830/CVJA-2010-067
Peripartum cardiomyopathy (PPCM) is a relatively rare form
of acute heart failure associated with pregnancy,
1
and defined
as the onset of acute heart failure in the last trimester or early
postpartum period, in the absence of infectious, metabolic,
toxic, ischaemic and valvular causes of myocardial dysfunction.
2
Many terms are used to describe this disorder, including toxic
post-partal heart failure, postpartum heart disease, postpartum
myocardosis, Meadows’ syndrome, idiopathic myocardial degen-
eration associated with pregnancy, Zaria syndrome, and postpar-
tum cardiomyopathy.
3-4
The diagnosis of this disorder is said to depend on the follow-
ing criteria: (1) development of congestive heart failure (CHF)
secondary to decreased left ventricular systolic function in the
last month of pregnancy or within five months after delivery;
(2) absence of pre-existing cardiac dysfunction; (3) absence of
determinable cause of cardiomyopathy; and more recently, (4)
left ventricular systolic dysfunction demonstrated by classic
echocardiographic criteria: left ventricular ejection fraction less
than 45%, or M-mode fractional shortening less than 30%, or
both, and end-diastolic dimension more than 2.7 cm/m
2
.
5,6
The Hausa tribe of northern Nigeria has the highest known
incidence in the world; about 13% of all female admissions
having this condition,
7
and the incidence has been reported to be
as high as 1:100. This is probably related to a local Hausa custom
of ingesting a form of lake salt in the immediate postpartum peri-
od, a practice that can produce significant volume overload.
8
The
disease is less common among other ethnic groups in Nigeria.
The anaesthetic management of labour and delivery in
pregnant patients with peripartum cardiomyopathy is not well
defined and we are unaware of any case report on the anaesthetic
management of this subset of patients presenting for Caesarean
section (CS) in West Africa. We therefore present a patient with
peripartum cardiomyopathy requiring CS who was managed
with combined spinal–epidural (CSE) anaesthesia.
Case report
A 30-year-old housekeeper with body mass index of 22.2 kg/m
2
,
G
4
P0
+3
, was transferred from a peripheral hospital where she
had presented at 34 weeks of gestation with pregnancy-induced
hypertension and symptoms of cardiac failure. On admission,
she gave a history of a week of breathlessness, with cough
productive of scanty, whitish, frothy sputum, and associated
orthopnoea. She had a previous history of pedal oedema of
one month’s duration before presentation. She was not a known
hypertensive, diabetic or asthmatic and had no history of drug
allergy. There was no previous hospital admission except for a
voluntary termination of pregnancy six years earlier.
At the time of admission, she was dyspnoeic lying down, her
heart rate was 120 beats per minute and blood pressure (BP)
was 160/120 mmHg. On auscultation of the chest, there were
bilateral coarse crackles along with a triple rhythm. The chest
radiograph showed cardiomegaly with bilateral pleural effusion.
The electrocardiogram (ECG) showed sinus tachycardia with
widespread ST–T changes in the anterolateral leads and left
atrial enlargement. The echocardiogram showed a dilated left
atrium, poor left ventricular systolic function, restrictive diastolic
dysfunction and mild pericardial effusion about 1 cm over the
left ventricle with left ventricular ejection fraction of 39%. More
Department of Anesthesia, College of Medicine, University
of Ibadan, Nigeria
BABATUNDE OSINAIKE, MB ChB, DA, FMCA, drosinaike@yahoo.
co.uk
Department of Anesthesia, University College Hospital,
Ibadan, Nigeria
JOHNSON OGAH, MBBS, DA
