Cardiac surgery under cardiopulmonary bypass in pregnancy: report of four cases

Abstract

Background Open heart surgery during pregnancy is relatively rare at home and abroad, and there is a higher risk and probability of maternal and infant death. How to carry out heart valve replacement under cardiopulmonary bypass (CPB) under the premise of ensuring the safety of mother and child is the focus of attention at home and abroad. Case introduction We reported four cases of cardiac surgeries under CPB during pregnancy performed in our hospital from March 2020 to March 2021. Two of the patients continued their pregnancy after cardiac surgery under CPB. Three patients had infective endocarditis and the other one had an ascending aortic aneurysm. Three patients underwent heart valve placement with the mechanical mitral valve when the other one underwent Bentall surgery. The operations of four cases were all successful, and further follow-up evaluation of the pregnant women and fetuses showed no abnormalities. The patients' detailed information is shown in the following table. Conclusion Heart disease during pregnancy should be treated actively and proactively when the patient has obvious symptoms. Heart valve replacement under CPB will be the first choice, and this may become the primary surgical treatment for symptomatic heart disease during pregnancy.

Infective Endocarditis during Pregnancy—Keep It Safe and Simple!

“…Cardiac surgery is also associated with a high risk for the fetus. Clinical guidelines recommend postponing cardiac surgery as much as possible until 6 weeks postpartum, and if not possible then to perform cardiac surgery in the second trimester between 13–28 weeks of pregnancy [ 139 , 140 ]. In some cases, the fetus may have transient or spontaneous bradycardia, which may subside at the end of surgery.…”

“…Prematurity and stillbirth occur most frequently in urgent cases, accompanied by high surgical risk, multiple maternal co-morbidities or low gestational age [ 145 ]. Peri-operatively, administration of progesterone prevents uterine contractions and magnesium sulphate and atosiban contribute to fetal protection and maintenance of viability [ 140 ]. It is recommended as much as possible to reduce the CBP time, increase the infusion rate and continue antibiotic therapy for up to 6 weeks after surgery [ 151 ].…”

Perfusion management in the excision of a right atrial mass in a beating heart with robotic surgery in a pregnant patient with situs inversus totalis

“…[3,4] Olgumuzda da olduğu gibi, KPB'ye başlamadan hemen önce bebeğin sezaryen ile doğumunun gerçekleştirilmesi güvenli seçenek olarak görülmektedir. [5] Minimal invaziv kalp cerrahisi, son yıllarda yaygınlaşarak birçok merkezde uygulanmaya başlanmıştır. Minimal invaziv robotik cerrahi…”

Pregnancy After Cardiac Surgery

“…You et al [ 2 ] demonstrated that with the use of cardiopulmonary bypass (CPB), we were able to successfully conduct cardiac surgery on four pregnant women who had heart problems. The other two women carried on with their pregnancies following heart surgery, while two of them underwent simultaneous cardiac surgery and cesarean sections.…”