Severe endocarditis and open-heart surgery during pregnancy

Kastelein, Arnoud W.; Oldenburger, Nanne Y; Pampus, Maria G. van; Janszen, Erica W. M.

doi:10.1136/bcr-2016-217510

Cited by 7 publications

(5 citation statements)

References 10 publications

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“…More than half of patients with IE deliver before term, at an average gestational age of 32 weeks [ 125 ]. The small number of cases presented in the literature provides little data on neonatal prognosis [ 126 ].…”

Section: From Pathophysiology To Multidisciplinary Assessmentmentioning

confidence: 99%

Infective Endocarditis during Pregnancy—Keep It Safe and Simple!

et al. 2023

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The diagnosis of infective endocarditis (IE) during pregnancy is accompanied by a poor prognosis for both mother and fetus in the absence of prompt management by multidisciplinary teams. We searched the electronic databases of PubMed, MEDLINE and EMBASE for clinical studies addressing the management of infective endocarditis during pregnancy, with the aim of realizing a literature review ranging from risk factors to diagnostic investigations to optimal therapeutic management for mother and fetus alike. The presence of previous cardiovascular pathologies such as rheumatic heart disease, congenital heart disease, prosthetic valves, hemodialysis, intravenous catheters or immunosuppression are the main risk factors predisposing patients to IE during pregnancy. The identification of modern risk factors such as intracardiac devices and intravenous drug administration as well as genetic diagnostic methods such as cell-free deoxyribonucleic acid (DNA) next-generation sequencing require that these cases be addressed in multidisciplinary teams. Guiding treatment to eradicate infection and protect the fetus simultaneously creates challenges for cardiologists and gynecologists alike.

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Section: From Pathophysiology To Multidisciplinary Assessmentmentioning

confidence: 99%

Infective Endocarditis during Pregnancy—Keep It Safe and Simple!

et al. 2023

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“…Available studies of this scenario are limited to case reports due to the low prevalence, and fetal outcomes are usually grim . There have been a few successes, however, in rescuing both the mother and fetus . Here we report a case of fetal outcome improved through several strategies, enacted on during the perioperative period.…”

Section: Introductionmentioning

confidence: 95%

Survival of the fetus during maternal thoracotomy under cardiopulmonary bypass for infective endocarditis

Luo

Sun

Chen

et al. 2017

J of Obstet and Gynaecol

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Infective endocarditis (IE) during pregnancy is a rare but serious condition. Cardiopulmonary bypass during pregnancy has a high rate of fetal morbidity and mortality. We here report the case of a 22-year-old pregnant woman with confirmed IE. Multiple large cardiac valve vegetations, severe aortic valve regurgitation, and hemodynamic compromise were observed. With full implementation of fetal monitoring and protection strategies, open heart surgery was performed at 31.4 weeks' gestation to aid survival, followed by an elective cesarean delivery at 34.4 weeks. As of the 3-month follow-up, both the mother and infant were in good health. This shows that a fetus can survive maternal thoracotomy under cardiopulmonary bypass with proper perioperative management, which means that this technique does not need to be excluded from consideration in the treatment of IE complicating pregnancy.

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“… 5 While maternal outcomes from cardiac surgery are reportedly similar to non-pregnant women, current literature on management is limited to case series and retrospective reviews and data on neonatal outcomes have not been characterized. 3 , 6 , 7 Discussions regarding indications and timing of valve surgery are particularly complex given poor fetal outcomes with cardiopulmonary bypass. 6 , 7 Consequently, delivering effective care often requires coordination among several specialties.…”

Section: Introductionmentioning

confidence: 99%

“… 3 , 6 , 7 Discussions regarding indications and timing of valve surgery are particularly complex given poor fetal outcomes with cardiopulmonary bypass. 6 , 7 Consequently, delivering effective care often requires coordination among several specialties. Multidisciplinary endocarditis teams for management of infective endocarditis have been shown to reduce in-hospital and 1-year mortality.…”

Section: Introductionmentioning

confidence: 99%

Management of infective endocarditis in pregnancy by a multidisciplinary team: a case series

Shapero

Nauriyal

Megli

et al. 2022

Therapeutic Advances in Infection

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Introduction: The incidence of infective endocarditis (IE) in pregnancy is rare and has been increasing during the opioid epidemic. IE in pregnancy is associated with high rates of maternal and fetal morbidity and mortality. Multidisciplinary endocarditis teams for management of IE have been shown to reduce in-hospital and 1-year mortality. We present a single-center experience managing IE in pregnancy utilizing a multidisciplinary endocarditis team. Methods: Patients diagnosed with IE while pregnant or within 30 days post-partum were identified. All patients discussed at the institution’s weekly multidisciplinary endocarditis meeting were included. Demographic and clinical data and outcome-related variables were retrospectively reviewed and recorded. Results: Between 1 October 2020 and 1 June 2021 6 pregnant or 30-day post-partum patients with IE were identified. All patients had co-morbid injection drug use; Staphylococcus aureus was the etiologic pathogen in all patients. All patients had embolic complications and 5 required ICU admission and mechanical ventilatory support. Four patients underwent valve replacement. There were no patient-directed discharges. All patients survived to hospital discharge and 90-days after diagnosis. Four pregnancies resulted in delivery at an average gestational age of 32.4 weeks with 3 requiring NICU admissions and prolonged lengths of stay. All patients were seen by addiction medicine and 5 were started on medication-assisted treatment for opioid use disorder. Discussion: In a small retrospective cases series, coordination of care by a multidisciplinary endocarditis team led to a high-rate of surgical intervention with no patient-directed discharges and no in-hospital or 90-day mortality. Conclusion: Multidisciplinary endocarditis teams are a low-risk intervention that may improve outcomes in pregnant patients with IE.

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Severe endocarditis and open-heart surgery during pregnancy

Cited by 7 publications

References 10 publications

Infective Endocarditis during Pregnancy—Keep It Safe and Simple!

Infective Endocarditis during Pregnancy—Keep It Safe and Simple!

Survival of the fetus during maternal thoracotomy under cardiopulmonary bypass for infective endocarditis

Management of infective endocarditis in pregnancy by a multidisciplinary team: a case series

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