Aranyosi János, Aranyosi János, Péterffy Arpád
Debreceni Egyetem, Orvos- és Egészségtudományi Centrum, Szülészeti és Nogyógyászati Klinika, Debrecen.
Magy Seb. 2008;61 Suppl:17-21. doi: 10.1556/MaSeb.61.2008.Suppl.6.
Heart disease during pregnancy necessitating cardiac surgery is potentially increasing maternal and fetal morbidity and mortality. Most patients know about their heart disease long before conception however the relation between the deteriorating cardiac function and the perinatal complications is not emphasized. Best possible results can be achieved by providing preconception counseling for cardiac patients. Consequently, heart-surgery can be performed before pregnancy thereby the maternal risk is lower and fetal loss or induced abortion can be avoided. The pregnant state is not optimal for cardiac surgery as the principal interest of the mother and the fetus is different. Cardiac surgery should be reserved only for saving the patient's life when medical therapy proves insufficient or when conservative management leads to acute heart failure. The multidisciplinary approach, correct risk assessment, diagnosis, operative indication, timing along with appropriate anaesthesia, extracorporeal circulation and alert monitoring of the uterine activity and fetal heart rate patterns make the intervention technically safe. Fetal monitoring is inevitable for prompt correction of operative conditions in case of impending hypoxemia. The perioperative fetal risk can be reduced by applying normothermia, high mean arterial pressure and cardiac index during the intentionally shortest intervention. Cardiac operation with cardiopulmonary bypass during pregnancy has become a relatively safe procedure for the mother but not for the baby.
孕期需要心脏手术的心脏病可能会增加孕产妇和胎儿的发病率及死亡率。大多数患者在受孕前很久就知道自己患有心脏病，然而，心脏功能恶化与围产期并发症之间的关系并未得到重视。通过为心脏病患者提供孕前咨询，可以取得最佳效果。因此，可以在怀孕前进行心脏手术，从而降低孕产妇风险，避免胎儿丢失或人工流产。怀孕状态并非心脏手术的最佳时机，因为母亲和胎儿的主要利益不同。只有在药物治疗证明不足或保守治疗导致急性心力衰竭时，心脏手术才应仅用于挽救患者生命。多学科方法、正确的风险评估、诊断、手术指征、时机选择以及适当的麻醉、体外循环和对子宫活动及胎儿心率模式的严密监测，使干预在技术上是安全的。胎儿监测对于在即将出现低氧血症时迅速纠正手术条件是必不可少的。在尽可能短的干预过程中，通过采用正常体温、高平均动脉压和心脏指数，可以降低围手术期胎儿风险。孕期进行体外循环心脏手术对母亲来说已成为一种相对安全的手术，但对胎儿并非如此。
