P096 Anesthetic management of a heart-transplanted parturient in spontaneous labour: a case report

<h3></h3> <b>Please confirm that an ethics committee approval has been applied for or granted</b>: Yes: I’m uploading the Ethics Committee Approval as a PDF file with this abstract submission <h3>Background and Aims</h3> Pregnancy in heart transplant recipients presents complex anesthetic and obstetric challenges, primarily due to cardiac denervation and altered physiological responses to labour. Despite increasing prevalence, evidence guiding management remains limited. This case highlights the importance of multidisciplinary coordination and individualized anesthetic planning to ensure maternal and fetal safety throughout labour and delivery. <h3>Methods</h3> A 36-year-old primigravida with a history of orthotopic heart transplantation five years earlier for dilated cardiomyopathy was carefully followed throughout pregnancy by a multidisciplinary team. Her care included tailored immunosuppressive therapy and trimesterly cardiology evaluations, with a recent (1-month-old) transthoracic echocardiogram with preserved biventricular function. At 37 weeks and 2 days of gestation, she presented to our center in spontaneous labour. <h3>Results</h3> The patient presented with labour-related pain, was hemodynamically stable, with no signs of acute cardiac decompensation. Preeclampsia was diagnosed and magnesium sulfate was initiated. Given the underlying cardiac history, continuous monitoring was implemented, including 5-lead ECG and invasive arterial blood pressure, to enable early detection of potential cardiovascular instability. Preemptive epidural analgesia was initiated during early labour (2 cm of cervical dilation) using titrated ropivacaine 0.2% and a single 5 mcg bolus of sufentanil. This approach ensured effective analgesia and maternal comfort without compromising hemodynamic stability. During contractions, transient periods of hypotension were noted, but there was no need for vasoactive support. After 12 hours of labour, the patient had an uncomplicated spontaneous vaginal delivery of a live newborn weighing 2045 g. Postpartum care included continued invasive monitoring. <h3>Conclusions</h3> Heart-transplanted parturients require individualized anesthetic care prioritizing early neuraxial analgesia and continuous invasive monitoring to ensure hemodynamic stability and attenuate adrenergic response. Given their increased risk for complications such as arrhythmias, acute heart failure, and pre-eclampsia, prompt intervention and close monitoring is critical. This case highlights the pivotal role of anesthesiologists in optimizing care for this high-risk population.