Intracardiac Surgery in Pregnant Women

Becker, Ronald M.

doi:10.1016/s0003-4975(10)60486-9

Cited by 149 publications

(57 citation statements)

References 5 publications

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“…By contrast, Becker [7] suggested that high-flow, high pressure normothermic perfusion during cardiopulmonary bypass is probably safer for the fetus than the use of hypothermia during cardiopulmonary bypass.…”

Section: Discussionmentioning

confidence: 99%

Surgery for acute type A aortic dissection in pregnant patients with Marfan syndrome

Sakaguchi

Kuwabara

Seto

et al. 2005

European Journal of Cardio-Thoracic Surgery

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Objective: Acute type A aortic dissection during pregnancy can be fatal to both the mother and the fetus. The goal of the present study was to characterize the prevalence, treatment and outcomes of this dangerous condition in an effort to determine optimal management. Methods:A retrospective study was conducted using data from four Marfan patients with acute type A aortic dissection during pregnancy at our institution between 1991 and 2003. Results:The mean gestational period at the time of operative repair was 31 weeks, with a range of 26-34 weeks, and the aortic root diameter ranged from 35 to 85 mm. Two of the four patients underwent a combined operation with caesarean section followed by aortic repair. One patient underwent operative aortic repair following spontaneous delivery. The final patient underwent aortic repair with the fetus remaining in situ.Median sternotomy and cardio-pulmonary bypass were established via the femoral artery with direct right atria drainage and left atrial venting in all patients. Composite graft replacement combined with re-implantation of the coronary artery and aortic valve replacement were performed in three patients, and aortic valve replacement with coronary artery bypass grafting of the right coronary artery was performed in one patient. Three of four patients underwent aortic arch repair utilizing antegrade cerebral perfusion and deep hypothermia with total circulatory arrest. The patent that underwent operative correction with the fetus remaining in situ experienced fetal demise with miscarriage just after cardiac surgery, and the patient died four days later secondary to disseminated intravascular coagulation and multi-organ failure. The remaining three cases recovered uneventfully, and the mothers and babies were discharged in good condition. Conclusions:Based on these data, we advocate Caesarean section with concomitant aortic repair for patients with Marfan syndrome and acute type A aortic dissection during pregnancy. Minimization of deep hypothermic circulatory arrest time is also recommended for cases in which the fetus remains in situ.

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Section: Discussionmentioning

confidence: 99%

Surgery for acute type A aortic dissection in pregnant patients with Marfan syndrome

Sakaguchi

Kuwabara

Seto

et al. 2005

European Journal of Cardio-Thoracic Surgery

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“…Both the cooling and the rewarming phases are associated with increased sustained uterine contractions. 20 This obser- vation is supported by the fact that there is a notably higher fetal mortality rate with hypothermic than with normothermic CPB. 18 The excitability of uterine muscle is probably enhanced by hormonal dilution, mainly by the dilution of progesterone.…”

Section: Uterine Response To Maternal Cardiopulmonary Bypassmentioning

confidence: 95%

“…20,34,35 Increased gestational age and increased hypothermia are factors known to increase fetal morbidity during CPB. 36 Unfortunately, little experimental evidence is available on the fetal response to maternal CPB.…”

Section: Fetal Response To Cardiopulmonary Bypassmentioning

confidence: 99%

“…44 External monitoring of the fetal heart rate and the uterus is only an indirect measure of fetoplacental physiology, but it assists in the early recognition of the potentially deleterious effects of CPB, thus enabling timely intervention to minimize fetal mortality. 19,20,37 Continual and frequent monitoring of the fetus postoperatively is also recommended, because there is a risk of preterm labor in this period. 48 …”

Section: Fetal Response To Cardiopulmonary Bypassmentioning

confidence: 99%

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Cardiac surgery during pregnancy

Conolly¹,

Khan²

2012

Core Topics in Cardiac Anesthesia

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A pproximately 2% to 4% of women of childbearing age have concomitant heart disease.1 In the Western world, congenital heart disease (CHD) accounts for most of the structural heart disease that affects women of childbearing age.2 Acquired cardiac disease seen during pregnancy is mainly valvular in nature, usually a consequence of rheumatic fever.2 Even though rheumatic fever is decreasing in developed countries, it continues to be a serious problem in the developing world. Immigrants also form a high-risk population, especially those who are unaware of the inherent risks of heart disease during pregnancy or are even unaware of the presence of any cardiac disease. Mitral stenosis is the most common lesion encountered, 2 although its incidence is on the decline. Aortic valve disease is less common: aortic incompetence is usually a consequence of endocarditis (1 in 8,000 pregnancies) or aortic dissection, in which case there may be an underlying connective tissue disorder such as Marfan syndrome. Significant aortic stenosis is uncommon in this age group.3 Ischemic events during pregnancy are rare. The incidence of myocardial infarction is approximately 1 in 10,000 pregnancies. 4,5 Infarction is usually secondary to underlying coronary artery disease, although spontaneous coronary artery dissection seems to be more common during pregnancy and accounts for 30% of all myocardial infarctions seen in pregnancy. 6,7 Predictors of Maternal and Fetal OutcomeIn the United Kingdom, cardiac disease in the mother is the major cause of maternal death during pregnancy. Of these patients, 25% have CHD. 8 In a large, prospective multicenter study of pregnancy outcomes among women with heart disease, adverse maternal cardiovascular events were seen in 13% of patients. Independent predictors of maternal cardiac complications included prior cardiac events, New York Heart Association functional class III/IV or cyanosis, left-heart obstruction, and left ventricular systolic dysfunction (Table I). Neonatal complications were seen in 20% and were associated with poor functional class or cyanosis, left-heart obstruction, or smoking. 9A recent prospective observational study in pregnant patients with CHD found that both cardiac complication and neonatal complication rates were considerable in these women. In mothers, right subpulmonary ventricular systolic dysfunction and severe pulmonary regurgitation were predictors of an adverse fetal outcome. 10 In a recently published literature review that described the outcomes of 2,491 pregnancies among women with structural CHD, substantial cardiac complications were seen in 11% of the pregnancies. Obstetric complications did not appear to be more prevalent,

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“…Entretanto, a mortalidade fetal elevou-se após a introdução da CEC, devida a ocorrência do trabalho de parto prematuro e ao óbito fetal intra-operatório (hipóxia) 4 . Devido ao melhor conhecimento das repercussões fetais, ocasionadas pela CEC, o aprimoramento desta técnica tem determinado a diminuição da mortalidade fetal.…”

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Cirurgia valvar em gestantes. Experiência em oito casos

Pomerantzeff¹,

Benício²,

Brandão³

et al. 1998

Arq. Bras. Cardiol.

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Purpose -Os primeiros relatos de cirurgias cardíacas, realizadas durante a gravidez, surgiram no início da década de 50 1 , ainda no período de cirurgia cardíaca a céu fechado, sem circulação extracorpórea (CEC), observando-se que a mortalidade materna não estava aumentada em relação ao mesmo tipo de cirurgia realizada em não gestantes 2,3 . Entretanto, a mortalidade fetal elevou-se após a introdução da CEC, devida a ocorrência do trabalho de parto prematuro e ao óbito fetal intra-operatório (hipóxia) 4 . Devido ao melhor conhecimento das repercussões fetais, ocasionadas pela CEC, o aprimoramento desta técnica tem determinado a diminuição da mortalidade fetal. O objetivo deste estudo é analisar a evolução materna e fetal de oito gestantes submetidas à cirurgia cardíaca. MétodosForam analisadas retrospectivamente, oito gestantes submetidas à cirurgia cardíaca sob CEC entre janeiro/86 e dezembro/98. A idade das gestantes variou de 19 a 44 (média de 31,4±7,4) anos. A idade gestacional variou de 12 a 31 (mé-dia de 26,6±7,1) semanas.

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Intracardiac Surgery in Pregnant Women

Cited by 149 publications

References 5 publications

Surgery for acute type A aortic dissection in pregnant patients with Marfan syndrome

Surgery for acute type A aortic dissection in pregnant patients with Marfan syndrome

Cardiac surgery during pregnancy

Cirurgia valvar em gestantes. Experiência em oito casos

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