Volume 5, Issue 1, January 2019, Page: 21-25
Continuous Cardiac Doppler of the Fetus Guiding an Aortic Valve Replacement in an Eighteen Weeks Pregnant Woman with Active Endocarditis
Nadine Kawkabani, Department of Cardiac Anesthesia, Saint George Hospital-University Medical Center, University of Balamand, Beirut, Lebanon
Roula Darwish, Department of Cardiac Anesthesia, Saint George Hospital-University Medical Center, University of Balamand, Beirut, Lebanon
Moussa Abi Ghanem, Department of Cardiothoracic Surgery, Saint George Hospital-University Medical Center, University of Balamand, Beirut, Lebanon
Simon Bejjani, Department of Cardiothoracic Surgery, Saint George Hospital-University Medical Center, University of Balamand, Beirut, Lebanon
Omar Boustros, Department of Cardiothoracic Surgery, Saint George Hospital-University Medical Center, University of Balamand, Beirut, Lebanon
Rawad Halimeh, Department of Obstetrics-Gynecology-Foetal Maternal Division, Saint George Hospital-Medical Center-University, University of Balamand, Beirut, Lebanon
Joe Khalifeh, Department of Obstetrics-Gynecology-Foetal Maternal Division, Saint George Hospital-Medical Center-University, University of Balamand, Beirut, Lebanon
Assaad Maalouf, Department of Cardiology, Saint George Hospital-University Medical Center, University of Balamand, Beirut, Lebanon
Bassam Abou Khalil, Department of Cardiothoracic Surgery, Saint George Hospital-University Medical Center, University of Balamand, Beirut, Lebanon
Elie Anastasiades, Department of Obstetrics-Gynecology-Foetal Maternal Division, Saint George Hospital-Medical Center-University, University of Balamand, Beirut, Lebanon
Received: Feb. 8, 2019;       Accepted: Mar. 19, 2019;       Published: May 15, 2019
DOI: 10.11648/j.ijcts.20190501.15      View  105      Downloads  16
Abstract
Two percent of pregnant women experience some type of cardiac pathologic disease. In some cases surgery becomes mandatory to save the mother’s life. The maternal mortality rate in pregnant women undergoing open heart procedures is around 2.9% while the fetal mortality rate ranges between 9.5 to 29%. Many papers have advanced measures in order to decrease fetal morbidity and mortality such as tepid to normothermic cardiopulmonary bypass, good oxygenation, high hematocrit, pulsatile flow, alpha stat management, mean arterial pressure around 70mmhg and a pump flow above 2.4l/min. They recommend also a close monitoring of the fetal heart rate, uteroplacental blood flow and uterine contractions We report in this paper, the case of a 26 year old pregnant female who underwent at 18 weeks an aortic valve replacement. Severe fetal bradycardia occurred 30 min after going on bypass lasted for 20 min and was refractory to a further increase in pump flow, mean arterial pressure and hematocrit. The fetal heart rate returned to its baseline only after rewarming the patient to 35.5 degrees Celsius. The post-operative course was uneventful and a close follow up revealed a normal fetal status. At 38 weeks the mother delivered a healthy normal baby girl. Since fetal bradycardia occurred despite respecting all the recommendations and only reversed after rewarming the mother to 35.5 degrees Celsius, we would suggest not lowering the temperature during cardiopulmonary bypass below 35.5 degrees in pregnant patients undergoing cardiac procedures. Thus more reports and papers are mandatory in order to further elucidate the factors responsible of the adverse events that occur in such cases.
Keywords
Pregnant Woman, Cardiac Surgery, Fetal Bradycardia, Continuous Fetal Cardiac Doppler
To cite this article
Nadine Kawkabani, Roula Darwish, Moussa Abi Ghanem, Simon Bejjani, Omar Boustros, Rawad Halimeh, Joe Khalifeh, Assaad Maalouf, Bassam Abou Khalil, Elie Anastasiades, Continuous Cardiac Doppler of the Fetus Guiding an Aortic Valve Replacement in an Eighteen Weeks Pregnant Woman with Active Endocarditis, International Journal of Cardiovascular and Thoracic Surgery. Vol. 5, No. 1, 2019, pp. 21-25. doi: 10.11648/j.ijcts.20190501.15
Copyright
Copyright © 2019 Authors retain the copyright of this article.
This article is an open access article distributed under the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0/) which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
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