TITLE:
Cardiac Surgery during Pregnancy—Our Experience
AUTHORS:
Vivek Madhav Kanhere, Anjali Vivek Kanhere, Devashish Chakravarty, Nikhil Pendse, Milan Pendse, Munir Ahmed Khan, Anita Shrivastava, Vinod Narkhede
KEYWORDS:
Cardiac Surgery, Cardiopulmonary Bypass, Fetal Outcome, Maternal Outcome, Pregnancy
JOURNAL NAME:
World Journal of Cardiovascular Surgery,
Vol.7 No.8,
August
17,
2017
ABSTRACT: Background:
Rheumatic heart disease (RHD) continues to be endemic in developing countries like
India, thus a number of female patient present with valvular heart disease complicating
pregnancy. Surgery is lifesaving in patients who are symptomatic on medical management.
Objective: To study maternal and fetal outcome in patient’s refractory to medical
treatment undergoing cardiac surgery during pregnancy. Methodology: Analysis of
8 pregnant patients who underwent cardiac surgery during 5 years from Jan 2012 to
Dec 2016 in a Medical college setup in Central India. Results: Maternal age ranged
between 20 - 35 mean
of 23.75, NYHA class IV, refractory to medical treatment. The underlying cardiac lesion was rheumatic heart disease
7 (87.5%)
cases, 6 (85.7%)
had mitral valve lesion. 7 primigravida (87.5%) patients were taken as elective
procedure in second trimester (18 - 26 weeks), one multipara patient as emergency after failed
Balloon mitral valvuloplasty (BMV) in third trimester of pregnancy (32 weeks) was
the only maternal death. 5 (62.5%)
patients progressed to term pregnancy and delivered vaginally. The cardiopulmonary
bypass variables studied were Median bypass time 51.25 minutes (range 37 - 78), median cross-clamp time 25.62 minutes (range 16 - 48), Median
flow rate 2.4 l/min/m2 (range 2.2 - 2.6) mean
perfusion pressure during CPB 65 - 89 (range 55 - 120) and
median perfusate temperature 37°C (range 32 - 38). 2 (29%) patients had a long term follow-up and have delivered
at term in their next pregnancies at the institute. Conclusion: Cardiac Surgery
can be performed during pregnancy in patients’ refractory to medical management.
The outcome is better with mother than fetus. Multidisciplinary team approach is
the strategy for care.