Emergency tricuspid valve replacement during pregnancy.
A 36 year-old intravenous drug user at 19 weeks' gestation required emergency tricuspid valve replacement for severe tricuspid regurgitation and cardiogenic shock refractory to medical therapy. Normothermic, pulsatile, high-flow, and pressure cardiopulmonary bypass (CPB) was used in the absence of fetal monitoring. Ten days postoperatively, the patient miscarried. She was discharged from hospital two months following surgery. High-flow (> 3.0 L/min(2)), high-pressure (> 70 mmHg), normothermic CPB using pulsatile flow and blood cardioplegia is thought to offer the best outcome to the fetus, although data to support these claims are not compelling.
Price
James W
JW
Department of Anesthesiology, Pharmacology and Therapeutics, Vancouver General Hospital, University of British Columbia, Vancouver, BC V5Z 4E3, Canada. wallacep@interchange.ubc.ca
Klas
Matt
M
D000022:Abortion, Spontaneous; D002315:Cardiopulmonary Bypass / Q000379:methods; D005260:Female; D019918:Heart Valve Prosthesis Implantation / Q000379:methods; D006801:Humans; D011247:Pregnancy; D011249:Pregnancy Complications, Cardiovascular / Q000601:surgery*; D012770:Shock, Cardiogenic / Q000150:complications / Q000601:surgery*; D015819:Substance Abuse, Intravenous / Q000150:complications; D014262:Tricuspid Valve Insufficiency / Q000150:complications / Q000601:surgery*