Cavalieri R L, Watkins L, Abraham R A, Berkay H S, Niebyl J R
Obstet Gynecol. 1982 Jan;59(1):124-5.
A case of acute bacterial endocarditis with aortic valve abscess, aortic insufficiency, and congestive heart failure at 32 weeks' gestation is described. Prompt valve replacement is indicated due to the risks of embolism to the coronary arteries and brain, and to the high mortality of such patients with medical management only. The infant was delivered prematurely to avoid the intraoperative risks to the fetus of cardiac surgery. General rather than regional anesthesia was chosen because venous pooling from a regional block would necessitate preoperative fluid loading and vasopressor therapy, which would be stressful for an already failing heart. In the presence of severe congestive heart failure, the patient underwent cesarean section and delivered a health 2020-g male infant; 36 hours later the aortic valve was successfully replaced with a no. 21 Byork-Shiley prosthesis. The infecting organism was Streptococcus viridans.
本文描述了一例妊娠32周时发生急性细菌性心内膜炎并伴有主动脉瓣脓肿、主动脉瓣关闭不全和充血性心力衰竭的病例。由于存在冠状动脉和脑栓塞风险，以及仅采用药物治疗此类患者的高死亡率，故需及时进行瓣膜置换。为避免心脏手术对胎儿造成术中风险，婴儿提前分娩。选择全身麻醉而非区域麻醉，因为区域阻滞导致的静脉淤血需要术前补液和使用血管升压药治疗，这对本已衰竭的心脏会造成压力。在严重充血性心力衰竭的情况下，患者接受了剖宫产，产下一名健康的2020克男婴；36小时后，成功用21号比约克-希利人工瓣膜替换了主动脉瓣。感染病原体为草绿色链球菌。
