Shone's anomaly complicated by ascending aortic aneurysm in a pregnant woman

Anesthetic management of a parturient with Shone's syndrome -a case report with review of literature

BACKGROUND

Shone's syndrome is a rare complex congenital cardiac condition, characterized by a supra-valvular mitral ring, parachute deformity of the mitral valve, aortic stenosis, and coarctation of the aorta.

CASE

A 26-year-old parturient with partial Shone's syndrome presented to our delivery unit in pulmonary edema. She underwent a scheduled cesarean section performed under a combined spinal-epidural anesthetic at 33 weeks. She had multidisciplinary input from the cardiac, obstetric, and anesthetic teams, which led to a good outcome. A review of the five published case reports of Shone's syndrome in pregnancy is presented along with key findings.

CONCLUSIONS

Our case report and the review highlight the successful use of combined spinal-epidural anesthetic and provides guidance to the multidisciplinary team on the varied presentation and the optimum management of women with Shone's syndrome during the peripartum period.

An atypical presentation of chronic Stanford type A aortic dissection during pregnancy

Aortic dissection is a rare but devastating disease during pregnancy, usually presenting with sharp pains on the chest or back. We report a pregnant woman suffering from chronic Stanford type A aortic dissection presented with atypical symptoms without pain in the third trimester with markedly dilated aortic root and congestive heart failure, who received concomitant cesarean delivery and aortic repair with good maternal and fetal outcomes. Multidisciplinary approach and tight hemodynamic control are very important. More attention should be paid to those atypical symptoms so as to early identify this scarce but disastrous disease during pregnancy.

Shone's anomaly: a report of one case in sub-Saharan Africa

Shone's anomaly is a rare congenital cardiac malformation consisting of four obstructive lesions of the left heart and the aortic arch: a supramitral membrane; parachute mitral valve; subaortic stenosis; and coarctation of the aorta which occurs most commonly in its incomplete form. We report on a 17-year-old male Cameroonian with a variant of shone anomaly consisting of sub-valvular aortic stenosis, coarctation of the aorta and parachute mitral valve. He was referred for the investigation of a cardiac murmur after he presented with shortness of breath preceded by flu like syndrome. He underwent successful management abroad consisting of aortic coarctation treatment by percutaneous angioplasty and resection of the subaortic ring by traditional surgical approach without any mitral valve repair. Shone's anomaly is a rare congenital heart disease that can be missed in low resource settings. This case raises awareness about this syndrome, highlights the importance of cardiac ultrasonography in resource limited settings and illustrates the need for comprehensive service frameworks to improve access and level of care and services for patients in the African context.

The anesthetic management for cesarean delivery in a patient with Shone's syndrome

Shone's syndrome is a rare congenital cardiac condition that consists of up to four obstructive left-sided cardiac lesions. We report a 17-yr-old nullipara with Shone's syndrome who presented for cesarean delivery. She had mild mitral stenosis and mild left ventricular outflow tract obstruction. Epidural anesthesia was attempted, but the patient developed severe hypotension associated with fetal bradycardia necessitating immediate cesarean delivery under general anesthesia. The peripartum anesthetic and management considerations for these patients are discussed.

[Shone's anomaly Fallbericht und Hintergrund]

Shone's anomaly was first described in 1963 as a developmental complex of four potentially obstructive cardiac lesions including a supravalvular fibrous mitral ring, deformity of the mitral and/or subvalvular apparatus, subvalvular aortic stenosis and coarctation of the aorta. While paediatric patients with Shone's anomaly have been reported in the literature, only a few adult patients presenting with this anomaly have been described in the perioperative period. However, patients with an undiagnosed, incomplete form of Shone's anomaly might occasionally present for non-cardiac surgery as adults. In this case report we describe the anaesthetic management of an adult patient scheduled for a non-cardiac operation, who suffered from Shone's anomaly that was unrecognised prior to the operation.