Short-acting Beta 1-adrenergic Blocker is Useful for Anesthetic Management of Cesarean Section in a Patient with Marfan Syndrome

The aortic root dilatation and its dissection are the most catastrophic events in pregnancy with Marfan syndrome as has been reported. It has been shown that prophylactic beta-adrenergic blocker is effective in reducing the aortic distensibility. However, its fetal toxicity should be considered. It includes hypoglycemia, neonatal apnea and bradycardia. Landiolol hydrochloride is a new beta-adrenergic blocker of which greatest advantages are its short duration of action, rapid clearance and high beta 1-selectivity. This drug has not been evaluated in its maternal and fetal effects on human pregnancy. We report a case of Marfan syndrome complicated with 49 mm annuloaortic ectasia. She received landiolol for the prevention of aggravated aortic root dilatation during cesarean section. After the administration of spinal anesthesia, she was treated with landiolol by continuous infusion at a rate of 0.003 to 0.005 mg · kg^-1 · min^-1 until delivery of 1764 g infant with Apgar scores of 5 (1 min) and 8 (5 min). We could maintain maternal hemodynamics stable and good post cesarean uterus contraction. No severe adverse effects were observed in the infant. In conclusion, it is useful for maintaining the hemodynamics stable in a pregnant woman with Marfan syndrome and keep the infant safe from any adverse effects by infusing of landiolol.