Epidural analgesia and vaginal delivery in a patient with aortic stenosis and insufficiency.

OBJECTIVE To report a successful vaginal delivery using slow infusion of epidural analgesia in a patient with both severe aortic stenosis and insufficiency. CLINICAL PRESENTATION AND INTERVENTION A 26-year-old primigravid patient presented to our hospital for delivery. She had aortic stenosis and insufficiency due to rheumatic fever. Although the obstetrician recommended cesarean section owing to her cardiac status, she insisted upon vaginal delivery. We performed low-dose epidural analgesia with 10 ml of 0.125% ropivacaine and 20 μg fentanyl. She had spontaneous vaginal delivery without complication. CONCLUSION This case showed that in spite of the cardiac pathology, vaginal delivery under low-dose slow infusion of epidural analgesia was successful and therefore may be a safe alternative to cesarean section for cardiac patients.