Caesarean section in patients with heart-lung transplants: a report of three cases and review

There are increasing numbers of combined heart-lung transplants being carri ed out in young people for end-stage pulmonary disease. There have-to-date been few reports of pregnancy in heart-lung transplant recipients. We repor t on the successful outcome of three pregnancies involving two patients fol lowing heart-lung transplantation. The importance of an interdisciplinary a pproach to the care of such patients throughout pregnancy is clear. The del iveries were carried out by caesarean section under regional anaesthesia an d the discussion focuses on the choice of anaesthesia along with the proble ms these patients present to the anaesthetist. Regional anaesthesia appears to be a safe technique in these patients. However, it is important to appr eciate that the response to vasoactive drugs may be unpredictable and that intravenous fluid should be administered carefully as they are at risk of f luid overload and pulmonary oedema. (C) 2000 Harcourt Publishers Ltd.