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 i...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.展开更多
Background The requisite techniques for safe fetal cardiac arrest during cardiac interventions need to be further developed. Furthermore, little is known about the pathophysiologic effect of cardiopulmonary bypass（CP...Background The requisite techniques for safe fetal cardiac arrest during cardiac interventions need to be further developed. Furthermore, little is known about the pathophysiologic effect of cardiopulmonary bypass（CPB）at different levels of temperature with cardioplegic arrest on the developing fetus. Methods Twelve pregnant goats were randomly divided into hypothermic CPB group（H group）： cardiopulmonary bypass with perfusion at 30-32℃（n=6） and normothermic CPB group（N group）： cardiopulmonary bypass with perfusion at 36℃-38℃（n=6）. Fetal cardiopulmonary bypass was maintained including 30 minutes of cardiac arrest. Fetal mean arterial blood pressure（MAP） and heart rate（HR） were monitored. Fetal arterial blood samples were analyzed. The pulse index（PI） and resistance index（RI） of the fetal umbilical artery were recorded. Results The maternal weight,fetal weight and pump flow had no significant difference between the 2 groups. After clamp removal, two fetal hearts did not auto-beat in H group. The fetal HR and MAP b were significantly different（P〈0.05） etween the 2 groups. There was remarkable decreasing in post-CPB fetal HR and MAP in H group. A stable decrease in partial pressure of oxygen with a concomitant stable increase of carbon dioxide partial pressure in H group was noted.The lactic acid in H group was significantly higher than that in the N group（P〈0.05）. The PI and RI in H group were significantly elevated 1 hour after off CPB and further markedly increased 2 hours after off bypass. Conclusions Fetal CPB could be performed under both hypothermic and normothermic conditions. However, normothermic bypass may provide better delivery of oxygen to fetal tissue.展开更多
Fetal cardiac operation has been done in sheep so a method to protect the fetal and placenta after cessation of bypass is important.This is to review the progress in research of fetal cardiac bypass and prevention of ...Fetal cardiac operation has been done in sheep so a method to protect the fetal and placenta after cessation of bypass is important.This is to review the progress in research of fetal cardiac bypass and prevention of placental dysfunction.The placental dysfunction results from different factors such as distribution of blood flow,stress response,placental perfusion, hypothermia and higher pressure oxygen.Observations were made in fetal Cardiac Bypass.Administration of high dose of sodium nitropusside,the indomethacin,total spinal anesthetic to block the fetal stress response and the improvement the equipment of the cardiopulmonary bypass devices and the normotherimia with high flow can maintain the placental function.Currently informationindicates thatintrauterine correction of selected congenital cardiac defects will be available in human fetuses in notremote future.展开更多
文摘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.
基金supported by the National Natural Science Foundation of China(No.81370274)Guangdong Provincial Natural Science Foundation(No.2016A030310313)
文摘Background The requisite techniques for safe fetal cardiac arrest during cardiac interventions need to be further developed. Furthermore, little is known about the pathophysiologic effect of cardiopulmonary bypass（CPB）at different levels of temperature with cardioplegic arrest on the developing fetus. Methods Twelve pregnant goats were randomly divided into hypothermic CPB group（H group）： cardiopulmonary bypass with perfusion at 30-32℃（n=6） and normothermic CPB group（N group）： cardiopulmonary bypass with perfusion at 36℃-38℃（n=6）. Fetal cardiopulmonary bypass was maintained including 30 minutes of cardiac arrest. Fetal mean arterial blood pressure（MAP） and heart rate（HR） were monitored. Fetal arterial blood samples were analyzed. The pulse index（PI） and resistance index（RI） of the fetal umbilical artery were recorded. Results The maternal weight,fetal weight and pump flow had no significant difference between the 2 groups. After clamp removal, two fetal hearts did not auto-beat in H group. The fetal HR and MAP b were significantly different（P〈0.05） etween the 2 groups. There was remarkable decreasing in post-CPB fetal HR and MAP in H group. A stable decrease in partial pressure of oxygen with a concomitant stable increase of carbon dioxide partial pressure in H group was noted.The lactic acid in H group was significantly higher than that in the N group（P〈0.05）. The PI and RI in H group were significantly elevated 1 hour after off CPB and further markedly increased 2 hours after off bypass. Conclusions Fetal CPB could be performed under both hypothermic and normothermic conditions. However, normothermic bypass may provide better delivery of oxygen to fetal tissue.
文摘Fetal cardiac operation has been done in sheep so a method to protect the fetal and placenta after cessation of bypass is important.This is to review the progress in research of fetal cardiac bypass and prevention of placental dysfunction.The placental dysfunction results from different factors such as distribution of blood flow,stress response,placental perfusion, hypothermia and higher pressure oxygen.Observations were made in fetal Cardiac Bypass.Administration of high dose of sodium nitropusside,the indomethacin,total spinal anesthetic to block the fetal stress response and the improvement the equipment of the cardiopulmonary bypass devices and the normotherimia with high flow can maintain the placental function.Currently informationindicates thatintrauterine correction of selected congenital cardiac defects will be available in human fetuses in notremote future.
