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体外循环下心内直视手术在妊娠中的应用:4 例报告。

Cardiac surgery under cardiopulmonary bypass in pregnancy: report of four cases.

机构信息

Thoracic and Cardiovascular Surgery, The Third Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, China.

Obstetrics and Gynecology Department, The Third Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, China.

出版信息

J Cardiothorac Surg. 2021 Sep 25;16(1):268. doi: 10.1186/s13019-021-01650-4.

Abstract

BACKGROUND

Open heart surgery during pregnancy is relatively rare at home and abroad, and there is a higher risk and probability of maternal and infant death. How to carry out heart valve replacement under cardiopulmonary bypass (CPB) under the premise of ensuring the safety of mother and child is the focus of attention at home and abroad.

CASE INTRODUCTION

We reported four cases of cardiac surgeries under CPB during pregnancy performed in our hospital from March 2020 to March 2021. Two of the patients continued their pregnancy after cardiac surgery under CPB. Three patients had infective endocarditis and the other one had an ascending aortic aneurysm. Three patients underwent heart valve placement with the mechanical mitral valve when the other one underwent Bentall surgery. The operations of four cases were all successful, and further follow-up evaluation of the pregnant women and fetuses showed no abnormalities. The patients' detailed information is shown in the following table.

CONCLUSION

Heart disease during pregnancy should be treated actively and proactively when the patient has obvious symptoms. Heart valve replacement under CPB will be the first choice, and this may become the primary surgical treatment for symptomatic heart disease during pregnancy.

摘要

背景

国内外妊娠期开胸心脏手术相对少见,母婴死亡风险和概率较高。如何在保障母婴安全的前提下开展体外循环(CPB)下心内直视手术,是国内外关注的焦点。

病例介绍

我们报道了 2020 年 3 月至 2021 年 3 月期间我院完成的 4 例 CPB 下妊娠心脏手术。其中 2 例患者 CPB 下心内直视手术后继续妊娠。3 例患者患有感染性心内膜炎,另 1 例患者患有升主动脉瘤。3 例患者行机械二尖瓣置换术,1 例患者行 Bentall 手术。4 例患者的手术均取得成功,对孕妇和胎儿的进一步随访评估未见异常。患者的详细信息如下表所示。

结论

当患者出现明显症状时,应积极主动地治疗妊娠合并心脏病。CPB 下心瓣膜置换术将是首选,这可能成为妊娠合并有症状性心脏病的主要手术治疗方法。

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引用本文的文献

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Cardiac operation under cardiopulmonary bypass during pregnancy.孕期体外循环下心脏手术。
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Cardiac interventions and cardiac surgery and pregnancy.心脏介入和心脏手术与妊娠。
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