General anesthesia with remifentanil for cesarean section in a parturient with severe mitral and tricuspid regurgitation

Valvular heart lesions have deleterious effects on hemodynamics in parturients during pregnancy. Cesarean section with an opioid-based general anesthesia is used to alleviate the adverse effects. We described a case of a 28-year-old primigravida at 37 weeks’ gestation with a diagnosis of severe mitral regurgitation, tricuspid regurgitation, and pulmonary hypertension in active labor. Cesarean section under general anesthesia using remifentanil was planned to provide a stable anesthesia and analgesia to minimize hemodynamic changes during surgery. The patient maintained reasonable hemodynamics during surgery. The neonate required transient ventilatory support with bag and mask until she obtained spontaneous respiration. We suggest that remifentanil is a reliable opioid that can produce stable hemodynamic conditions with transient neonatal respiratory depression during cesarean section under general anesthesia in a parturient with severe valvular heart disease and pulmonary hypertension.