Emergency aortic valve replacement in the 24th-week of pregnancy.
The incidence of heart disease during pregnancy has declined from 3.6% to approximately 1.5% over the last 25 years as a result of better medical and surgical care. Rheumatic heart disease still accounts for 75% of cases and the incidence of bacterial endocarditis during pregnancy is about 1 in 8000. Seaworth and Durack reviewed 124 cases found in the literature of a 40 year period. The experience of any anesthetist with such cases will thus be limited. In this case report a patient is described who required emergency aortic valve replacement in the 24th week of pregnancy. The effect of the non-pulsatile flow during the extracorporeal circulation on the foetal unit will be discussed. Recommendations for the perioperative management include a normothermic high flow, high pressure perfusion technique, monitoring of foetal heart rate and uterine activity and vigorous tocolysis using beta sympathomimetics and progesterone.
Korsten
H H
HH
Department of Anesthesiology, Catharine Hospital, Eindhoven, The Netherlands.
Van Zundert
A A
AA
Mooij
P N
PN
De Jong
P A
PA
Bavinck
J H
JH
D000208:Acute Disease; D000328:Adult; D001022:Aortic Valve Insufficiency / Q000209:etiology / Q000601:surgery*; D002315:Cardiopulmonary Bypass; D004697:Endocarditis, Bacterial / Q000150:complications; D005260:Female; D006340:Heart Rate, Fetal; D006801:Humans; D007231:Infant, Newborn; D011247:Pregnancy; D011249:Pregnancy Complications, Cardiovascular / Q000601:surgery*; D013290:Streptococcal Infections