Cardiac Surgery during Pregnancy-Our Experience
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Date
2017-08
Journal Title
Journal ISSN
Volume Title
Publisher
Scientific Research
Abstract
Background: Rheumatic heart disease (RHD) continues to be endemic in developing
countries like India, thus a number of female patient present with
valvular heart disease complicating pregnancy. Surgery is lifesaving in patients
who are symptomatic on medical management. Objective: To study maternal
and fetal outcome in patient’s refractory to medical treatment undergoing
cardiac surgery during pregnancy. Methodology: Analysis of 8 pregnant patients
who underwent cardiac surgery during 5 years from Jan 2012 to Dec
2016 in a Medical college setup in Central India. Results: Maternal age ranged
between 20 - 35 mean of 23.75, NYHA class IV, refractory to medical treatment.
The underlying cardiac lesion was rheumatic heart disease 7 (87.5%)
cases, 6 (85.7%) had mitral valve lesion. 7 primigravida (87.5%) patients were
taken as elective procedure in second trimester (18 - 26 weeks), one multipara
patient as emergency after failed Balloon mitral valvuloplasty (BMV) in third
trimester of pregnancy (32 weeks) was the only maternal death. 5 (62.5%) patients
progressed to term pregnancy and delivered vaginally. The cardiopulmonary
bypass variables studied were Median bypass time 51.25 minutes
(range 37 - 78), median cross-clamp time 25.62 minutes (range 16 - 48), Median
flow rate 2.4 l/min/m2 (range 2.2 - 2.6) mean perfusion pressure during
CPB 65 - 89 (range 55 - 120) and median perfusate temperature 37˚C (range
32 - 38). 2 (29%) patients had a long term follow-up and have delivered at
term in their next pregnancies at the institute. Conclusion: Cardiac Surgery
can be performed during pregnancy in patients’ refractory to medical management.
The outcome is better with mother than fetus. Multidisciplinary
team approach is the strategy for care.
Description
Keywords
Cardiac Surgery, Cardiopulmonary Bypass, Fetal Outcome, Maternal Outcome, Pregnancy
Citation
World Journal of Cardiovascular Surgery, 2017, 7, 103-109