Emergency Redo Mitral Valve Replacement in a Pregnant Woman at Third Trimester Case Report and Literature Review

Anesthetic Management of a Voluminous Left Atrial Myxoma Resection in a 19 Weeks Pregnant with Atypical Clinical Presentation

“…In order to provide adequate utero-placental perfusion and to guarantee fetal protection [23,24], current recommendations suggest: high perfusion pressure (>70 mmHg), high flow (2.5 L/min/m 2 ), and pulsatile, normothermic CPB [19,22]. Maternal hematocrit >28% is also recommended for optimizing oxygen transfer [23] and a-Stat pH management, in order to protect the fetus against hypocapnia and uteroplacental vasoconstriction [4].…”

Non-Obstetric Surgery During Pregnancy

“…25 Gebelik fizyolojik bir olay olmasına karşın, hemodinamik ve kardiyak fonksiyonlarda belirgin değişikliklere yol açarak, kardiyovasküler sistemin yükünü artırmakta ve gebelik öncesinde kardiyak hastalığı olan kadınlarda sorunların ağır-laşmasına sebep olabilmektedir. 2,26,27 Başlıca deği-şiklikler; kalp atım volümünde, kalp hızında, kalp debisinde ve nabız basıncında artış, ayrıca sistemik damar direncinde ve kan basıncında azalmalardır. Gebelik sırasında oluşan fizyolojik değişikliklerden en önemlisi; plazma volümünün artması ve bunun sonucu olarak da kardiyak outputta %30-50 oranında artış olmasıdır.…”

Cardiopulmonary bypass in pregnancy

“…[9,16] Fetal circulation during CPB has not been well-investigated. [17] CPB may result in lower placental flow and pressure, which are worsened by hypothermia and this results in impaired placental perfusion and respiratory gas exchange. [18] Although increasing CPB flow rates are preferable to improve placental perfusion, sympathomimetic agents such as ephedrine and phenylephrine (considered safe in pregnancy) can be used to maintain perfusion pressure and improving placental perfusion.…”

“…[9,21] Improved fetal outcomes have been reported when the intra-aortic balloon pump has been electively used with CPB, to mimic pulsatile flow physiologically and improve uterine perfusion. [17,22] Pulsatile flow prevents the drop in placental perfusion and limits the rise in placental vascular resistance that is observed with the Neonatologist and obstetrician on standby for emergency delivery non-pulsatile flow. [23] It preserves endothelial nitric oxide synthesis and decreases the activation of the fetal renin-angiotensin pathway, resulting in improved blood flow to the feto-placental unit.…”

“…[34] FETAL HEART MONITORING Bradycardia, because of placental hypoperfusion, is the most frequent fetal response to CPB and is usually reversible by increasing the perfusion. [17] Fetal bradycardia invariably occurs at the onset of CPB and the reason for this is not clearly defined. [35,36] The various causes for bradycardia postulated, include feto-placental dysfunction; fetal hypoxia and acidosis; maternal hypothermia; hypothermia at the onset of CPB; [35] and drugs that cross the placental barrier, such as β-adrenergic blockers.…”