Matsuda Hitoshi, Ogino Hitoshi, Neki Reiko, Kitamura Soichiro
Department of Cardio-Vascular Surgery, National CardioVascular Center, Suita, Osaka, 5-7-1 Fujishirodai, Suita, Osaka 565-8565, Japan.
Eur J Cardiothorac Surg. 2006 Jun;29(6):1061-3. doi: 10.1016/j.ejcts.2006.03.030. Epub 2006 May 3.
A 20-year-old woman with Marfan syndrome in the 19 weeks of pregnancy was admitted for a dissecting aneurysm of the ascending aorta to the proximal arch. She wanted to continue with pregnancy. A cardiotocography and a trans-esophageal echo probe which allowed visualization of the fetal heart contraction were attached on the abdomen. A cardio-pulmonary bypass was established via the right axillar and femoral arteries with bicaval drainage. The aortic isthmus and arch branches were clamped. After opening the ascending aorta, selective cerebral perfusion was initiated by quick cannulation into the left carotid and left subclavian arteries. Peripheral pressure was maintained above 80 mmHg with the flow of the selective cerebral perfusion at 1.0 L/min and flow from the femoral artery at 3.5L/min. Hemi-arch replacement was performed using a Dacron graft. The body temperature passively descended to 35 degrees C. She normally delivered a healthy female baby after 37 weeks' of gestation.
一名患有马凡综合征、妊娠19周的20岁女性因升主动脉至近心弓部夹层动脉瘤入院。她希望继续妊娠。在腹部连接了胎心监护仪和经食管超声探头，以便观察胎儿心脏收缩情况。通过右腋动脉和股动脉建立体外循环，采用双腔静脉引流。夹闭主动脉峡部和弓部分支。打开升主动脉后，通过快速插管至左颈动脉和左锁骨下动脉开始选择性脑灌注。选择性脑灌注流量为1.0L/分钟，股动脉流量为3.5L/分钟，外周压力维持在80mmHg以上。使用涤纶补片进行半弓置换。体温被动降至35摄氏度。妊娠37周后，她顺利产下一名健康女婴。
