Cardiopulmonary bypass in pregnancy

Pomini, Francesco; Mercogliano, Domenico; Cavalletti, Cristina; Caruso, Alessandro; Pomini, P

doi:10.1016/0003-4975(95)00818-7

Cited by 176 publications

(92 citation statements)

References 39 publications

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“…However, there is significant risk of fetal morbidity, early fetal mortality, and potential late neurological impairment. 4 The optimal timing for intervention is in the second trimester, which decreases the risk of fetal malformation or demise. Cesarean delivery before cardiopulmonary bypass is safe and recommended if the gestational age is >26 weeks.…”

Section: Discussionmentioning

confidence: 99%

Double Trouble

et al. 2016

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ForewordInformation about a real patient is presented in stages (boldface type) to expert clinicians (Drs Ganame, Whitlock, Velianou, and Natarajan), who respond to the information, sharing their reasoning with the reader (regular type). A discussion by the authors follows. P atient presentation: A 29-year-old woman born in Canada, gravida 3, para 2 at 12 weeks gestation, presented to the cardiac pregnancy clinic with a 1-month history of progressive shortness of breath on exertion and chest discomfort. Her medical history was significant for stenosis of a congenital bicuspid aortic valve for which she underwent surgical aortic valve replacement with a #23 Carpentier-Edwards Perimount Magna ease porcine bioprosthetic valve 5 years earlier at the age of 24. There was a questionable history of rheumatic fever at the age of 21; investigations revealed positive antistreptolysin and Sjögren-specific antibody A titers. She was treated with valproic acid for an irregular tremor thought to be Syndenham chorea. The pathology from her surgery did not reveal any evidence of rheumatic disease.She went on to have 2 successful pregnancies at the age of 26 and 27 years without complications. Her last formal review was 1 year before, during her second pregnancy at 34 weeks gestation. Echocardiography showed mild prosthetic valve aortic stenosis with a peak/mean gradient of 41/27 mm Hg, normal ejection fraction, with increased gradients across the prosthetic valve thought to be secondary to a high-output state. She became pregnant unexpectedly 9 months after her second pregnancy and now had progressive shortness of breath and typical angina on exertion; she was unable to climb 1 flight of stairs or push her baby's stroller without having to stop for prolonged periods. Her medications included aspirin, monthly intramuscular penicillin, and maternal vitamins. On physical examination, her blood pressure was 105/66 mm Hg, heart rate 101 beats/min regular, and normal respiratory rate; oxygen saturation was 98% on room air. She was comfortable and in no acute distress. Jugular venous pressure was 5 cm above the sternal angle with a negative abdominojugular reflex. Carotid pulse was of normal volume and contour, with no audible bruits. There was a midline sternotomy scar and the apical impulse was sustained. Auscultation revealed a normal S1, grade 2 late-peaking systolic ejection murmur best heard at the base with radiation to the carotid base, soft S2, and no S3 or S4. Lungs were clear to auscultation bilaterally. There was no pedal edema, all peripheral pulses were palpable, and the abdomen was soft, nontender. A 12-lead ECG revealed sinus tachycardia, with normal axis, normal intervals, and borderline left ventricular hypertrophy by voltage criteria (Figure 1).Dr Ganame: Dyspnea in pregnancy is a common presentation encountered by family physicians, emergency physicians, general internists, obstetricians, respirologists, and cardiologists. A thorough review should be performed to assess whether the symptoms are part of the normal ...

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Section: Discussionmentioning

confidence: 99%

Double Trouble

et al. 2016

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“…Risk factors for fetal mortality during surgery include the use of hypothermia and surgery during the third trimester [38,39]. The risk for fetal malformations may be higher with cardiac surgery performed during the first trimester, while intervening during the third trimester may increase the risk for preterm delivery and maternal mortality [39].…”

Section: Aortic Dissectionmentioning

confidence: 99%

“…Cardiac surgery during pregnancy can be performed with a maternal mortality rate of 3 % and risk of fetal loss of 20 % [38]. Risk factors for fetal mortality during surgery include the use of hypothermia and surgery during the third trimester [38,39].…”

Section: Aortic Dissectionmentioning

confidence: 99%

Management of the pregnant woman with Marfan syndrome complicated by ascending aorta dilation

Cox

Ginde

Kuhlmann

et al. 2014

Arch Gynecol Obstet

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“…El solo uso del bypass cardiopulmonar, por cualquier motivo, puede llegar a tener una mortalidad materna de 3%. En relación al feto, la mortalidad puede llegar a 20%, lo que se explica por la hipotermia, la que reduce el flujo placentario y aumenta las contracciones uterinas 4 , todo lo cual, se ve agravado al utilizar hipotermia profunda y paro circulatorio. En definitiva la coincidencia de síndrome de Marfán con embarazo y disección aórtica tiene muy baja frecuencia y es un desafío clínico sin conceptos terapéuticos definidos 8 .…”

Section: Comentariosunclassified

“…Presentan un riesgo de disección aórtica, incluso sin dilatación de la aorta, de alrededor de 1% 2,3 . Cuando se produce durante el embarazo y requiere intervención quirúrgica (disección tipo A), la mortalidad materna es elevada (20% a 30 %) 4 .…”

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Disección aórtica y síndrome de Marfán en el embarazo: A propósito de un caso clínico

et al. 2009

Rev. méd. Chile

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Aortic dissection is a life-threatening disease that requires immediate surgical intervention. Marfan syndrome is a hereditary disease with an autosomal dominant transmission, which affects the connective tissue, with skeletal, cardiovascular and ocular involvement. It is one of the most prevalent connective tissue disorders, presenting a risk of aortic dissection of approximately 1% even without dilatation of the aorta. When dissection occurs during pregnancy and requires surgical intervention (type A dissection), maternal mortality is high (20%-30%). We report a 38 year-old woman with (Rev Méd Chile 2009; 137: 98-100).

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Cardiopulmonary bypass in pregnancy

Cited by 176 publications

References 39 publications

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Management of the pregnant woman with Marfan syndrome complicated by ascending aorta dilation

Disección aórtica y síndrome de Marfán en el embarazo: A propósito de un caso clínico

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