Cardiopulmonary bypass during pregnancy is associated with a high fetal and maternal mortality. We report a successful pulmonary embolectomy in a woman at the 27th week of pregnancy; we performed surgical pulmonary embolectomy under cardiopulmonary bypass to restore adequate hemodynamic stability and to relieve right ventricle strain. We discuss the decision made for the preferred anticoagulation drug in the setting of heparin-induced thrombocytopenia in the gravida. The pregnancy was carried to term and she delivered a healthy boy at 38 weeks of gestation.

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675F. Mitropoulos et al. / Interactive CardioVascular and Thoracic Surgery 13 (2011) 672-675 fistula to the coronary sinus is the direct run-off of cardioplegic solution to the right atrium; consequently the myocardium is not protected correctly. It is advisable to administer antegrade cardioplegia with digital compression of the fistula at the level of the coronary sinus [2, 3]. Retrograde cardioplegia represents a valuable alternative in the setting of a coronary artery fistula to the coronary sinus. Our technique would have been to administer antegrade cardioplegia with external compression of the coronary sinus then, after heart arrest, to perform a 2 cm longitudinal incision on the external aspect of the coronary sinus immediately prior to its distal extremity. This opening, which is obligatory to identify the entry point of the fistula, also allows us to introduce a retrograde cardioplegia cannula.

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nine (7%) patients; seven on prosthetic AVs and two on prosthetic MVs. Reoperation was required in 10 (7.5%) patients; 9 following MV replacement and 1 following AV replacement.Pomini et al.[4] conducted a retrospective review of the literature analysing 69 pregnant patients undergoing cardiac surgery with the use of CPB. There were reports of 2 (2.9%) maternal deaths and 14 (20.2%) foetal deaths. Mean CPB time was 50.5 min and the following complications were observed: maternal central nervous system (CNS) deficit in 4.3%, foetal CNS deficit in 1.4%, foetal malformation in 2.9%, foetal hydrocephaly in 1.4% and foetal harelip in 1.4%. It is important to note that there is some overlap in the two retrospective reviews presented by Parry and Westaby and Pomini et al.Weiss et al.[5] conducted a retrospective literature review of 59 pregnant patients undergoing cardiovascular surgery with the use of CPB. Mean maternal age was 28.2 years and mean gestational age was 20.7 weeks. Thirteen operations were carried out on an emergency basis and there were three (5.1%) reported cases of intrauterine death before surgery. Maternal mortality was reported in three (5.1%) cases, as a result of endocarditis of a mitral prosthesis and intracerebral bleeding, a ruptured aortic dissection and a massive pulmonary embolism with intra-abdominal bleeding. Foetal mortality was reported in 16 (29%) cases. Mean CPB time in the foetal mortality group and the foetal survival group were 74.3 and 77.8 min, respectively. The lowest temperatures during CPB in the two groups were 29.3 and 30.8°C, respectively. Normothermia (≥34°C) was maintained in 1 case in the foetal mortality group, whereas it was maintained in 10 cases in the foetal survival group.Salazar et al.[6] conducted a retrospective observational study of 15 pregnant patients undergoing cardiac surgery with the use of CPB. Mean maternal age was 26.7 years and mean gestational age was 17.9 weeks. Maternal mortality was reported in two (13.3%) cases and foetal mortality in five (38.5%) cases. Mean CPB and aortic cross-clamp times were 89.1 and 62.8 min, respectively. A mean arterial pressure of 67.8 mmHg was maintained at a mean temperature of 31.8°C. Jahangiri et al.[7] reported a case series of four pregnant patients undergoing cardiac surgery with the use of CPB, with all operations performed at 35°C. Mean maternal age was 30.8 years and mean gestational age was 17.3 weeks. There were no maternal mortalities. One foetal mortality occurred as a result of termination at 17 weeks' gestation following continued signs of foetal hydrops. Normal term delivery was observed in the other three cases. Median CPB and aortic cross-clamp times were reported at 101 and 88 min, respectively.Eight case reports [8-15] described 10 patients undergoing CPB. There were no reports of maternal mortality and one report of foetal mortality, with a stillborn foetus delivered 7 days postoperatively. Mean CPB and aortic cross-clamp times were 105 and 50 min, respectively.

Contained rupture of the left ventricle secondary to a myocardial abscess is uncommon. We present a case of infective endocarditis of the aortic valve with an unusual manifestation: a cardiac tamponade due to a pseudoaneurysm of the left ventricle.

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