Clinical experience with cardiac surgery with extracorporeal circulation on the heart and great vessels in pregnant patients in the second and third trimesters of pregnancy
Objective. To report the clinical experience of treatment in 7 patients who have undergone open heart surgery with extracorporeal circulation (EC) in the second and third trimesters of pregnancy.Bazylev V.V., Rosseikin E.V., Evdokimov M.E., Pantyukhina M.A., Kobzev E.E., Baranova Yu.A.
Subjects and methods. The mean age of the patients was 31(20—36) years; the mean gestation period was 32.5 (27—34) weeks. Cardiac surgery was repeated in four patients. Four urgent, two immediate, and one salvage surgeries were performed in a patient admitted to the hospital with the clinical presentations of interstitial pulmonary edema due to prosthetic mitral valve dysfunction.
Results. Cesarean section (CS) was performed simultaneously with cardiac surgery in 6 cases. In one case, pregnancy was prolonged and ended in elective CS at 38 weeks of gestation and in the birth of a boy with an Apgar score of 7/8. EC in all the patients was performed at a perfusion flow rate of 2.6—2.8 l/min/m2, in a normothermic state (venous blood temperature, 36.6-36.9°C), by using the pulsatile blood flow. The mean time of EC was 96 (58—137) minutes; that of aortic ligation was 61 (44—107) minutes. Pharmacological cold cardioplegia with histidine-tryptophan-ketoglutarate (HTK) solution was used for myocardial protection. Cardiotocography was employed to monitor fetal cardiac activity and uterine contractility. To prevent obstetric hemorrhage, the internal iliac arteries were ligated prior to heparin administration and EC.
The early postoperative period was complicated by bleeding from the pericardial cavity in two cases; one woman required pacemaker implantation; no uterine inflammatory changes or intestinal failure were noted. Female reproductive function was maintained in all the cases. All the patients were discharged from hospital in a satisfactory condition. Preterm newborn infants were transferred to a specialized neonatal intensive care unit and were subsequently discharged in a satisfactory condition.
Conclusion. Management of pregnant patients who need cardiac surgery is a serious ordeal for obstetricians/gynecologists, cardiac surgeons, anesthesiologists/resuscitators. The exchange of experience and well-coordinated collective work are an essential component of a successful pregnancy outcome in a woman and a fetus.
Keywords
cesarean section
pregnancy
extracorporeal circulation
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Received 08.09.2017
Accepted 22.09.2017
About the Authors
Bazylev Vladlen Vladlenovich, MD, doctor cardiovascular surgeon, chief physician of Federal Center of Cardiovascular Surgery, Ministry of Health of Russia.440071, Russia, Penza, Stasova str. 6. E-mail: cardio-penza@yandex.ru. ORCID ID: 0000-0001-6089-9722
Rosseykin Evgeniy Vladimirovich, MD, doctor cardiovascular surgeon, head of the Department, Federal Center of Cardiovascular Surgery, Ministry of Health of Russia. 440071, Russia, Penza, Stasova str. 6. ORCID ID: 0000-0003-0784-2246
Evdokimov Mikhail Evgenievich, MD, doctor anesthesiologist-resuscitator, head of the Department, Federal Center of Cardiovascular Surgery, Ministry of Health of Russia. 440071, Russia, Penza, Stasova str. 6. ORCID ID: 0000-0002-2434-7266
Pantyukhina Maya Aleksandrovna, anesthesiologist-resuscitator, Federal Center of Cardiovascular Surgery, Ministry of Health of Russia.
440071, Russia, Penza, Stasova str. 6. E-mail: lexei285@yandex.ru. ORCID ID: 0000-0001-7773-1168
Kobzev Evgeny Evgenievich, doctor cardiovascular surgeon, Federal Center of Cardiovascular Surgery, Ministry of Health of Russia. 440071, Russia, Penza, Stasova str. 6
Baranova Yulia Alexandrovna, anesthesiologist-resuscitator, Federal Center of Cardiovascular Surgery, Ministry of Health of Russia. 440071, Russia, Penza, Stasova str. 6
For citations: Bazylev V.V., Rosseikin E.V., Evdokimov M.E., Pantyukhina M.A., Kobzev E.E., Baranova Yu.A. Clinical experience with cardiac surgery with extracorporeal circulation on the heart and great vessels in pregnant patients in the second and third trimesters of pregnancy. Akusherstvo i Ginekologiya/Obstetrics and Gynecology. 2018; (5): 108-15. (in Russian)
https://dx.doi.org/10.18565/aig.2018.5.108-115
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