[A case of urgent aortic valve replacement for infective endocarditis in pregnancy].
A 31-year-old woman underwent urgent aortic valve replacement due to infective endocarditis at 16 weeks' gestation. Because of rapid and severe congestive heart failure, maternal rescue was regarded as the priority in the anesthetic management. Previous literature shows that high-flow high-pressure normothermic perfusion during cardiopulmonary bypass provides the best way of reducing fetal risk. Though it was not performed, the fetus was alive for 24 hours after the operation. Perioperative administration of dopamine and furosemide could have diminished uterine blood flow. If these drugs could have been avoided, the fetus may have stayed alive. However, considering the risk of teratogenesis due to drug administration and cardiopulmonary bypass, propriety of pregnancy prolongation is controversial.
Department of Anesthesia, Saiseikai Suita Hospital, Osaka 564-0013.
Yasuaki
Y
Takano
Hiroki
H
Matsuyama
Akiko
A
Fujita
Atsuko
A
Kobayashi
Mitsuyoshi
M
Kawamura
D000328:Adult; D000768:Anesthesia, General; D000773:Anesthesia, Obstetrical; D001021:Aortic Valve / Q000601:surgery*; D001022:Aortic Valve Insufficiency / Q000209:etiology* / Q000601:surgery*; D002315:Cardiopulmonary Bypass / Q000009:adverse effects; D004630:Emergencies; D004698:Endocarditis, Subacute Bacterial / Q000150:complications* / Q000382:microbiology; D005260:Female; D005313:Fetal Death / Q000209:etiology; D019918:Heart Valve Prosthesis Implantation; D006801:Humans; D011247:Pregnancy; D011249:Pregnancy Complications, Cardiovascular; D011251:Pregnancy Complications, Infectious; D013290:Streptococcal Infections; D034364:Streptococcus milleri Group; D016896:Treatment Outcome