Department of Obstetrics, Postgraduate Institute of Medical Education and Research, Chandigarh, India.
Department of Cardiothoracic and Vascular Surgery, Postgraduate Institute of Medical Education and Research, Chandigarh, India.
Braz J Cardiovasc Surg. 2023 Aug 4;38(5):e20220335. doi: 10.21470/1678-9741-2022-0335.
Cardiovascular disease is the leading cause of pregnancy-related mortality, and it has gradually increased over time; this rise has been attributed to numerous reasons including the growing number of women with congenital heart disease who are surviving to childbearing age. Valve surgery during pregnancy is a high risk, with a fetal and maternal mortality rate of 35% and 9%, respectively. Prior knowledge about the cardiovascular disease opens up a host of options for the mother even during pregnancy, but presentation in the 3rd trimester puts both the mother and the baby at risk. Simultaneous caesarean section and maternal cardiac surgery is a suitable option for this subset of patients, and with this study we aim to assess its outcomes and feasibility.
This is a retrospective study of five pregnant patients who presented with predominant symptoms of heart failure in the 3rd trimester between June 2019 and June 2021. Intraoperative and postoperative intensive care unit charts of all the patients were reviewed.
All five patients underwent simultaneous cesarean section and maternal cardiac surgery successfully with no fetal or maternal mortality and are doing well in the follow-up period.
Cesarean section followed by definitive maternal cardiac surgery in the same sitting is a safe and feasible approach in the management of such patients. A well-prepared team is pivotal for a safe delivery with a cardiopulmonary bypass machine on standby. Specialized multidisciplinary care in the antepartum, peripartum, and postpartum period is essential to improve outcomes.
心血管疾病是导致与妊娠相关的孕产妇死亡的主要原因，且其发病率呈逐渐上升趋势；这一上升趋势归因于多种原因，包括越来越多患有先天性心脏病的女性能够存活至生育年龄。妊娠期行心脏瓣膜手术风险较高，胎儿和孕产妇死亡率分别为 35%和 9%。预先了解心血管疾病为母亲提供了众多选择，即使在妊娠期间也是如此，但在妊娠晚期发病会使母亲和婴儿都面临风险。同期行剖宫产术和产妇心脏手术是这类患者的合适选择，本研究旨在评估其结局和可行性。
这是一项回顾性研究，纳入了 2019 年 6 月至 2021 年 6 月期间妊娠晚期因心力衰竭为主诉就诊的 5 例孕妇。回顾了所有患者的术中及术后重症监护病房图表。
所有 5 例患者均成功同期行剖宫产术和产妇心脏手术，无胎儿或孕产妇死亡，随访期间情况良好。
对于此类患者，剖宫产术后同期行确定性产妇心脏手术是一种安全且可行的方法。一个有备而来的团队对于在体外循环机备用的情况下安全分娩至关重要。围产前、围产期和产后的专门多学科护理对于改善结局至关重要。
