Department of Obstetrics and Gynecology, Massachusetts General Hospital.
Harvard Medical School, Boston, Massachusetts.
Clin Obstet Gynecol. 2020 Jun;63(2):429-446. doi: 10.1097/GRF.0000000000000533.
The need for cardiac surgery during pregnancy is rare. Only 1% to 4% of pregnancies are complicated by maternal cardiac disease and most of these can be managed with medical therapy and lifestyle changes. On occasion, whether due to natural progression of the underlying cardiac disease or precipitated by the cardiovascular changes of pregnancy, cardiac surgical therapy must be considered. Cardiac surgery is inherently dangerous for both, the mother and fetus with mortality rates near 10% and 30%, respectively. For some conditions, percutaneous cardiac intervention offers effective therapy with far less risk to the mother and her fetus. For others, cardiac surgery, including procedures that mandate the use of cardiopulmonary bypass, must be entertained to save the life of the mother. Given the extreme risks to the fetus, if the patient is in the third trimester, strong consideration should be given to delivery before surgery involving cardiopulmonary bypass. At earlier gestational ages when this is not feasible, modifications to the perfusion protocol including higher flow rates, normothermic perfusion, pulsatile flow, and the use of intraoperative external fetal heart rate monitoring should be considered.
怀孕期间需要心脏手术的情况很少见。只有 1% 到 4%的妊娠合并母体心脏疾病，其中大多数可以通过药物治疗和生活方式改变来管理。有时，由于潜在心脏疾病的自然进展或妊娠期间心血管变化的诱发，必须考虑心脏外科治疗。心脏手术对母亲和胎儿都有很大的风险，死亡率分别接近 10%和 30%。对于某些情况，经皮心脏介入治疗提供了有效的治疗方法，对母亲及其胎儿的风险要小得多。对于其他情况，包括需要使用体外循环的手术，必须进行心脏外科手术，以挽救母亲的生命。鉴于对胎儿的极端风险，如果患者处于妊娠晚期，强烈考虑在涉及体外循环的手术之前分娩。在不太可行的更早的孕龄期，应考虑修改灌注方案，包括更高的血流速度、常温灌注、脉动流和术中使用外部胎儿心率监测。
