title: Cardiac Interventions in Pregnant Patients without Fluoroscopy.
abstract: BACKGROUND
  Cardiac interventions with fluoroscopy during pregnancy carry significant risks for the fetus. This report reviews three pregnant patients: two of them requiring pacemaker implantation and one underwent diagnostic cardiac catheterization without fluoroscopy.
  
  
  METHODS
  The cases were performed using EnSite system (St. Jude Medical Inc., MN, USA) guidance. The necessary cardiac structure geometries were reconstructed with a deflectable quadripolar electrophysiology catheter without fluoroscopy. In two cases, pacemaker leads were connected to the EnSite system for navigation and fixation of leads. In the third case, long sheaths and electrophysiology catheters were used to access the right ventricle and pulmonary artery. Transthoracic echocardiography was also used in all three cases.
  
  
  RESULTS
  A 31-year-old woman at 8-week pregnancy was admitted with ventricular septal defect and significant pulmonary hypertension. The patient underwent catheterization to assess for the risk of continuation of pregnancy. There was partial reactivity, it was decided not to terminate the pregnancy, and an uneventful delivery was succeeded at 35 weeks of gestation without complications. The rest of the two pregnant patients were a 28-year-old pregnant woman at 14 weeks of gestation and a 40-year-old woman at 12-week gestation. Both of them presented with symptomatic complete AV block. A single-chamber pacemaker was implanted in the first one, and a dual-chamber pacemaker was implanted in the latter. Pregnancy continued in both without complications.
  
  
  CONCLUSIONS
  Successful cardiac catheterization and pacemaker implantation can be performed safely in selected pregnant patients using an electroanatomic mapping system guidance without fluoroscopy.
authors.affiliation: Pediatric and Genetic Arrhythmia Center, Istanbul Medipol University Hospital, Istanbul, Turkey.
authors.forename: Volkan
authors.initials: V
authors.lastname: Tuzcu
authors.forename: Enes Elvin
authors.initials: EE
authors.lastname: Gul
authors.forename: Abdullah
authors.initials: A
authors.lastname: Erdem
authors.forename: Hacer
authors.initials: H
authors.lastname: Kamali
authors.forename: Turkay
authors.initials: T
authors.lastname: Saritas
authors.forename: Cem
authors.initials: C
authors.lastname: Karadeniz
authors.forename: Celal
authors.initials: C
authors.lastname: Akdeniz
mesh_terms: D000328:Adult; D054537:Atrioventricular Block / Q000175:diagnosis* / Q000503:physiopathology / Q000628:therapy; D006328:Cardiac Catheterization / Q000379:methods*; D002304:Cardiac Pacing, Artificial / Q000379:methods*; D005260:Female; D006345:Heart Septal Defects, Ventricular / Q000150:complications / Q000175:diagnosis*; D006801:Humans; D006976:Hypertension, Pulmonary / Q000175:diagnosis* / Q000209:etiology; D010138:Pacemaker, Artificial; D011247:Pregnancy; D016896:Treatment Outcome