Anesthetic Management of Elective Cesarean Delivery in a Pregnant Patient with Dilated Cardiomyopathy and Pulmonary Hypertension: A Multidisciplinary Approach

Peripartum cardiomyopathy (PPCM) complicated by pulmonary arterial hypertension (PAH) is an uncommon and high-risk condition that presents significant anesthetic and obstetric challenges. This case report contributes to the limited literature by describing the successful anesthetic management of a parturient with severe cardiac dysfunction and PAH, emphasizing the importance of a multidisciplinary approach. A 30-year-old pregnant woman with newly diagnosed dilated cardiomyopathy of unknown etiology and PAH was admitted for elective cesarean delivery. The diagnosis was established in the second trimester following symptoms of dyspnea at rest. Transthoracic echocardiography revealed severe left ventricular systolic dysfunction and elevated pulmonary artery pressures. A combined spinal-epidural technique was selected to allow for gradual onset of anesthesia and tight hemodynamic control. The patient was managed in a multidisciplinary setting involving anesthesiology, cardiology, obstetrics, and intensive care. Intraoperative and postoperative periods were uneventful, with no signs of pulmonary edema or right ventricular failure. The patient was discharged in stable condition on postoperative day 7. This case highlights the critical importance of individualized anesthetic planning and collaborative multidisciplinary care in the management of high-risk obstetric patients with PPCM and PAH. Early diagnosis, careful monitoring, and tailored interventions are key to optimizing maternal and neonatal outcomes in such complex scenarios.