[接受体外循环心脏手术的孕妇的母婴结局]

[Maternal and fetal outcomes in pregnant patients undergoing cardiac surgery with cardiopulmonary bypass].

作者信息

Wang Huanying, Zhang Jun, Li Bin, Li Yanna, Zhang Haofeng, Wang Yaqin, Sun Lizhong, Meng Xu

机构信息

Department of Obstetrics and Gynecology, Beijing Anzhen Hospital Affiliated to Capital Medical University, Beijing 100029, China.

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出版信息

Zhonghua Fu Chan Ke Za Zhi. 2014 Feb;49(2):104-8.

PMID:24739641

Abstract

OBJECTIVE

To evaluate the optimal management of cardiac surgery during pregnancy, and the maternal and fetal outcomes in pregnant patients undergoing cardiac surgery with the use of cardiopulmonary bypass.

METHODS

Nine pregnant women with heart diseases were identified, who underwent cardiac surgery with cardiopulmonary bypass between January 2002 and March 2013. Patient charts were reviewed for pregnant age, types of heart diseases, surgical indication, parameters of cardiopulmonary bypass, and maternal and fetal outcomes.

RESULTS

Among 9 patients, there were 4 cases of valvular heart disease (two of rheumatic heart disease complicated with subacute bacterial endocarditis and heart failure, one of mechanical prosthetic valves flap after mitral replacement, one of severe aortic stenosis), one case of aortic dissection, three cases with atrial myxoma, and one case with tetralogy of Fallot. The New York Heart Association (NYHA) functional classification: there were three cases with class I, two with class II, two with class III, and two with class IV. Heart surgeries were performed from 9 to 39 weeks gestation. Five patients underwent heart surgery with cardiopulmonary bypass combined with cesarean section. The other 4 patients terminated pregnancies after heart surgeries, two of whom underwent uterine curettage in first trimester, one induction of labor in second trimester, and one continued to be pregnant until 37 weeks' gestation. Seven patients were alive. Nine fetal outcomes were included two with artificial abortion, one with induction of labor and one with cesarean section in second trimester, two of premature labor and three of full-term labor with cesarean section in third trimester. Five newborns were no malformation, four of whom were alive.

CONCLUSION

Cardiopulmonary bypass can be used safely with satisfactory maternal and fetal outcomes in pregnant patients with heart disease undergoing cardiac surgery.

摘要

目的

评估孕期心脏手术的最佳管理方法以及接受体外循环心脏手术的孕妇的母婴结局。

方法

确定9例患有心脏病的孕妇，她们在2002年1月至2013年3月期间接受了体外循环心脏手术。回顾患者病历，了解其孕周、心脏病类型、手术指征、体外循环参数以及母婴结局。

结果

9例患者中，有4例瓣膜性心脏病（2例风湿性心脏病合并亚急性细菌性心内膜炎和心力衰竭，1例二尖瓣置换术后机械瓣膜瓣叶问题，1例重度主动脉瓣狭窄），1例主动脉夹层，3例心房黏液瘤，1例法洛四联症。纽约心脏协会（NYHA）心功能分级：I级3例，II级2例，III级2例，IV级2例。心脏手术在妊娠9至39周进行。5例患者接受了体外循环心脏手术联合剖宫产。另外4例患者在心脏手术后终止妊娠，其中2例在孕早期行刮宫术，1例在孕中期引产，1例继续妊娠至37周。7例患者存活。9例胎儿结局包括2例人工流产，1例引产，1例孕中期剖宫产，2例早产，3例孕晚期足月剖宫产。5例新生儿无畸形，其中4例存活。