#36509 Spinal anesthesia for transurethral resection in a patient with severe asymptomatic aortic stenosis after balloon aortic valvuloplasty

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Background and Aims

One of the most prevalent serious valve disease problems is aortic stenosis. Patients with significant AS are often advised against receiving neuraxial anesthesia because they won’t be able to handle the crucial decrease in coronary perfusion pressure. We present a case of a successful transurethral resection under spinal anesthesia in a patient with severe asymptomatic AS which has been managed with balloon aortic valvuloplasty prior to the procedure.

Methods

An 81-year-old male, with a history of prostate cancer and a condition after prostatectomy, new-onset deep vein thrombosis of the left iliac vein, and newly detected severe asymptomatic aortic stenosis, was admitted to the hospital for a planned TUR due to tumor process of the urinary bladder. Echocardiography revealed preserved systolic function of the left ventricle, with severe aortic stenosis. In this case, TAVI was not indicated, so it was concluded that BAV would be performed to reduce the anesthetic risk. Balloon dilatation of the aortic valve was successfully performed. After a month from BAV, the patient was again admitted to the hospital for a planned surgical procedure. For TUR, a mixture of 0.5% bupivacaine, 40% glucose, and fentanyl was applied intrathecally at the L4-L5 level with a 27G needle.

Results

During the procedure the patient was stable, and TUR was done without any adverse effects. The patient was discharged home three days after surgery in good general condition.

Conclusions

In conclusion, our case report is evidence of successful outcome with spinal anesthesia in patient with adequately managed severe AS.