The use of remifentanil during general anaesthesia for caesarean delivery in two patients with severe heart dysfunction

We describe the management of two patients with severe heart dysfunction requiring caesarean section because of incipient left ventricular failure. One patient had a bicuspid valve and developed symptoms of severe aortic incompetence during pregnancy. The second patient had known hypertrophic obstructive cardiomyopathy and developed chest pain and symptoms of left ventricular failure at 32 weeks' gestation. In both cases the worsening cardiac disease prompted the decision for operative delivery. We decided to employ general anaesthesia and achieved cardiovascular stability using remifentanil as an adjunct.