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Wang Z, Zhong L, Guo H, Liu Y, Zhou C, Ye Y, Han F, Huang H. Case Report: Totally endoscopic minimally invasive mitral valve surgery during pregnancy: a case series. Front Cardiovasc Med 2024; 11:1300508. [PMID: 38468722 PMCID: PMC10926021 DOI: 10.3389/fcvm.2024.1300508] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2023] [Accepted: 02/06/2024] [Indexed: 03/13/2024] Open
Abstract
A totally endoscopic minimally invasive approach is widely used for cardiac valve surgery in normal adults. However, minimally invasive cardiac surgery during pregnancy is rarely reported. In addition to traditional median thoracotomy, totally endoscopic minimally invasive approaches can now be used for pregnant patients. We describe our experience with totally endoscopic cardiac valve surgery (TECVS) during pregnancy, which is safe for both mothers and fetuses.
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Affiliation(s)
- Zhenzhong Wang
- Department of Cardiac Surgery, Guangdong Provincial People’s Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, China
| | - Lishan Zhong
- Department of Cardiac Surgery, Guangdong Provincial People’s Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, China
| | - Haijiang Guo
- Department of Cardiac Surgery, Guangdong Provincial People’s Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, China
| | - Yanli Liu
- Department of Obstetrics, Guangdong Provincial People’s Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, China
| | - Chengbin Zhou
- Department of Cardiac Surgery, Guangdong Provincial People’s Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, China
| | - Yingxian Ye
- Department of Anesthesia, Guangdong Provincial People’s Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, China
| | - Fengzhen Han
- Department of Obstetrics, Guangdong Provincial People’s Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, China
| | - Huanlei Huang
- Department of Cardiac Surgery, Guangdong Provincial People’s Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, China
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Brandstetter M, Neuner M, Dinges C, Hofstätter E, Wohlmuth C, Fazelnia C, Fischer T, Bogner G. Fetal Doppler monitoring during maternal open-heart surgery: Case report and key aspects of a multidisciplinary challenge. Eur J Obstet Gynecol Reprod Biol 2023; 287:63-66. [PMID: 37295346 DOI: 10.1016/j.ejogrb.2023.05.034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Accepted: 05/25/2023] [Indexed: 06/12/2023]
Abstract
CASE REPORT Herein we present the case of a 33-year nulliparous woman at 21 weeks of gestation with mitral valve vegetation resulting from infective endocarditis. Due to the mother's critical condition caused by consecutive thromboembolic events, surgery with cardiopulmonary bypass was indicated. During surgery the fetus was monitored by a specialized obstetrician who repetitively measured the Doppler indices of the umbilical artery, Ductus venosus and uterine artery. Right after CO2 was insufflated into the operating area, the Doppler monitoring showed an increased Pulsatility Index of the Umbilical artery right before fetal distress with bradycardia occurred. A subsequent maternal arterial blood gas analysis showed an acidosis with hypercapnia. Consequently, the CO2 insufflation was stopped and the gas flow on the Heart Lung Machine increased. After regaining homeostasis of acidosis, the Doppler Indices and fetal heart rate recovered. The remaining surgery and postoperative course were uneventful. At the 37 weeks of gestation a healthy boy was delivered by Cesarean section and at the age of two years, the neurodevelopment was assessed, which indicated normal development in mental cognition, language and motoric. This report presents a periodic Doppler examination of the maternal and fetal circulation during surgery on CPB while also discussing the possible impact of fetal monitoring in managing open cardiac surgery in pregnancy.
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Affiliation(s)
| | - Matthias Neuner
- Department of Anesthesiology, Paracelsus Medical University, Salzburg, Austria
| | - Christian Dinges
- Department of Heart Surgery, Paracelsus Medical University, Salzburg, Austria
| | - Edda Hofstätter
- Department of Neonatology, Paracelsus Medical University, Salzburg, Austria
| | - Christoph Wohlmuth
- Department of Obstetrics and Gynecology, Paracelsus Medical University, Salzburg, Austria
| | - Claudius Fazelnia
- Department of Obstetrics and Gynecology, Paracelsus Medical University, Salzburg, Austria
| | - Thorsten Fischer
- Department of Obstetrics and Gynecology, Paracelsus Medical University, Salzburg, Austria
| | - Gerhard Bogner
- Department of Obstetrics and Gynecology, Paracelsus Medical University, Salzburg, Austria.
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Al Riyami N, Nair A, Al Lawati H, Al Kindi AH. Successful Management of Maternal Left Atrial Myxoma in Pregnancy. Oman Med J 2023; 38:e470. [PMID: 36742176 PMCID: PMC9884322 DOI: 10.5001/omj.2023.01] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2021] [Accepted: 09/12/2021] [Indexed: 11/03/2022] Open
Abstract
A 29-year-old woman (gravida 3, para 2) presented at 28 weeks+2 days of gestation with a two-months history of dyspnea associated with orthopnea and occasional palpitations. On transthoracic echocardiography, she was diagnosed with a 3.2 × 2.7 cm left atrial myxoma. The patient underwent open surgical resection at 30 weeks of gestation. She had an uneventful postoperative recovery and was discharged on the ninth day. At 41 weeks of gestation, she gave birth by cesarean to a healthy baby of normal weight. Both the mother and the baby were discharged in stable condition.
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Affiliation(s)
- Nihal Al Riyami
- Department of Obstetrics and Gynecology, College of Medicine and Health Sciences, Sultan Qaboos University, Muscat, Oman,Corresponding author:
| | - Asha Nair
- Department of Obstetrics and Gynecology, Sultan Qaboos University Hospital, Muscat, Oman
| | - Hatim Al Lawati
- Department of Medicine, Sultan Qaboos University Hospital, Muscat, Oman
| | - Adil H. Al Kindi
- Department of Surgery, Sultan Qaboos University Hospital, Muscat, Oman
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Makhija N, Tayade S, Tilva H, Chadha A, Thatere U. Pregnancy After Cardiac Surgery. Cureus 2022; 14:e31133. [DOI: 10.7759/cureus.31133] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2022] [Accepted: 11/05/2022] [Indexed: 11/07/2022] Open
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Cardiac disease in pregnancy. Best Pract Res Clin Anaesthesiol 2022; 36:191-208. [PMID: 35659955 DOI: 10.1016/j.bpa.2022.02.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Accepted: 02/16/2022] [Indexed: 11/22/2022]
Abstract
In the developed world, cardiovascular disease has become the most frequent cause of death during pregnancy and postpartum, outnumbering by far obstetric causes of death such as bleeding or thromboembolism. Many factors contribute to this phenomenon, including an increasing age of pregnant women, co-morbidities, and an unhealthy lifestyle. The cardiovascular system is not only significantly challenged by physiological alterations in pregnancy but also by obstetric medication. Depending upon the severity of the underlying condition, pregnant women with cardiovascular disease should be managed by a multidisciplinary heart team in which anaesthesiologists play an important role. Profound knowledge of the cardiac pathophysiology is a prerequisite for the successful anaesthesiologic management of pregnant patients with cardiovascular disease. As there is no difference in general and regional anaesthesia regarding maternal outcomes, neuraxial anaesthesia using incremental techniques should be preferred for labour and (caesarean) delivery if not contraindicated by non-cardiac issues.
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Lu A, Ye Y, Hu J, Wei N, Wei J, Lin B, Wang S. Case Series: Video-Assisted Minimally Invasive Cardiac Surgery During Pregnancy. Front Med (Lausanne) 2021; 8:781690. [PMID: 35004748 PMCID: PMC8727488 DOI: 10.3389/fmed.2021.781690] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2021] [Accepted: 11/09/2021] [Indexed: 11/16/2022] Open
Abstract
Surgical intervention is expected to improve maternal outcomes in pregnant patients with heart disease once the conservative treatment fails. For pregnant patients with heart disease, the risk of cardiac surgery under cardiopulmonary bypass (CPB) must be balanced due to the high fetal loss. The video-assisted minimally invasive cardiac surgery (MICS) has been progressively applied and shows advantages in non-pregnant patients over the years. We present five cases of pregnant women who underwent a video-assisted minimally invasive surgical approach for cardiac surgery and the management strategies. In conclusion, the video-assisted MICS is feasible and safe to pregnant patients, with good maternal and fetal outcomes under the multidisciplinary assessment and management.
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Affiliation(s)
- Anyi Lu
- Department of Anesthesiology, Guangdong Cardiovascular Institute & Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
- College of Medicine, Shantou University, Shantou, China
| | - Yingxian Ye
- Department of Anesthesiology, Guangdong Cardiovascular Institute & Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Jiaqi Hu
- Department of Anesthesiology, Guangdong Cardiovascular Institute & Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Ning Wei
- Department of Anesthesiology, Guangdong Cardiovascular Institute & Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Jinfeng Wei
- Department of Anesthesiology, Guangdong Cardiovascular Institute & Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Bimei Lin
- Department of Operation Room, Guangdong Cardiovascular Institute & Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Sheng Wang
- Department of Anesthesiology, Guangdong Cardiovascular Institute & Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
- Department of Anesthesiology, Linzhi People's Hospital, Linzhi, China
- *Correspondence: Sheng Wang
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Carlier L, Devroe S, Budts W, Van Calsteren K, Rega F, Van de Velde M, Rex S. Cardiac interventions in pregnancy and peripartum – a narrative review of the literature. J Cardiothorac Vasc Anesth 2020; 34:3409-3419. [DOI: 10.1053/j.jvca.2019.12.021] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2019] [Revised: 11/19/2019] [Accepted: 12/12/2019] [Indexed: 12/17/2022]
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8
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Rimmer L, Heyward-Chaplin J, South M, Gouda M, Bashir M. Acute aortic dissection during pregnancy: Trials and tribulations. J Card Surg 2020; 36:1799-1805. [PMID: 32996191 DOI: 10.1111/jocs.15068] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2020] [Revised: 09/08/2020] [Accepted: 09/09/2020] [Indexed: 12/19/2022]
Abstract
BACKGROUND Type A acute aortic dissection (TAAD) during pregnancy is a life-threatening event for both the mother and the unborn baby. Pregnancy has been recognized as an independent risk factor for TAAD, postulated to be due to physiological changes that cause hyperdynamic circulation. This review seeks to outline the current controversies around this unique group. METHODS A comprehensive literature search was carried out across large databases to assimilate relevant papers regarding acute aortic dissection in pregnant women. RESULTS The presentation can be atypical in many cases and further concern from clinicians of fetal radiation exposure can result in missed or delayed diagnoses. Investigation via the quickest form of imaging, whether computed tomography, magnetic resonance imaging, or transesophageal echocardiography, should be carried out promptly due to the high risk of mortality. Surgical management of TAAD in pregnancy revolves primarily around the decision to deliver the fetus concomitantly or to perform the aortic repair with the fetus in utero. CONCLUSIONS Management of this group includes rapid and dynamic assessment without delay. From conception to postpartum, there are multiple stages in which to manage these women. Challenges in carrying out management in the form of operative techniques and cardiopulmonary bypass place the fetus at risk and must be approached with caution, particularly as there is little evidence-base for many of these decisions. Further research into reducing maternal and fetal mortality is necessary.
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Affiliation(s)
- Lara Rimmer
- Vascular Surgery Department, Blackburn Hospital, East Lancashire Hospitals NHS Trust, Blackburn, UK
| | - Jessica Heyward-Chaplin
- Vascular Surgery Department, Blackburn Hospital, East Lancashire Hospitals NHS Trust, Blackburn, UK
| | - Matthew South
- Vascular Surgery Department, Blackburn Hospital, East Lancashire Hospitals NHS Trust, Blackburn, UK
| | - Mohamed Gouda
- Department of Vascular and Endovascular Surgery, Mataria Teaching Hospital, Cairo, Egypt
| | - Mohamad Bashir
- Vascular Surgery Department, Blackburn Hospital, East Lancashire Hospitals NHS Trust, Blackburn, UK
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Liu Y, Han F, Zhuang J, Liu X, Chen J, Huang H, Wang S, Zhou C. Cardiac operation under cardiopulmonary bypass during pregnancy. J Cardiothorac Surg 2020; 15:92. [PMID: 32404125 PMCID: PMC7218656 DOI: 10.1186/s13019-020-01136-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2019] [Accepted: 05/04/2020] [Indexed: 12/29/2022] Open
Abstract
Background Certain pregnant women suffer from cardiac pathology,and a few of them need cardiac operations under cardiopulmonary bypass during pregnancy. Feto-neonatal and maternal outcomes have not been sufficiently described. Methods We conducted a retrospective review of 22 cases of women undergoing cardiac operations under cardiopulmonary bypass during pregnancy in our hospital from Jan.2014 to Mar.2019. Results All 22 patients were alive after treatment. The types of cardiac disorders included congenital heart defects, rheumatic heart disease,infective endocarditis,aortic dissection, obstruction and/or thrombosis of a prosthetic valve. Only one case was a twin pregnancy,and the other 21 cases were singletons. Four fetuses died in the utero after surgery. Three patients chose termination of the pregnancy after the cardiac operations: one fetus was detected abnormity of the brain and the other two patients abandoned pregnancy. Fourteen fetuses were alive and born without any abnormity. Two fetuses suffered from neonatal intracranial hemorrhage and died after birth. Conclusions Cardiac operation under cardiopulmonary bypass during pregnancy is a challenge for physicians in multidisciplinary teams. Strictly evaluating the indication is vital. On the other hand, some patients can benefit from this management.
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Affiliation(s)
- Yanli Liu
- Department of Obstetrics, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, No. 106 Zhongshan 2nd road, Guangzhou, 510080, Guangdong, China
| | - Fengzhen Han
- Department of Obstetrics, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, No. 106 Zhongshan 2nd road, Guangzhou, 510080, Guangdong, China.
| | - Jian Zhuang
- Department of Cardiovascular Surgery, Guangdong Cardiovascular Institute, Guangdong Provincial Key Laboratory of South China Structural Heart Disease, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, Guangdong, China.
| | - Xiaoqing Liu
- Department of Epidemiology, Guangdong Cardiovascular Institute, Guangdong Provincial Key Laboratory of South China Structural Heart Disease, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, Guangdong, China
| | - Jimei Chen
- Department of Cardiovascular Surgery, Guangdong Cardiovascular Institute, Guangdong Provincial Key Laboratory of South China Structural Heart Disease, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, Guangdong, China
| | - Huanlei Huang
- Department of Cardiovascular Surgery, Guangdong Cardiovascular Institute, Guangdong Provincial Key Laboratory of South China Structural Heart Disease, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, Guangdong, China
| | - Sheng Wang
- Department of Anesthesia, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, Guangdong, China
| | - Chengbin Zhou
- Department of Cardiovascular Surgery, Guangdong Cardiovascular Institute, Guangdong Provincial Key Laboratory of South China Structural Heart Disease, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, Guangdong, China
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Harrison JHN, Arnolds DE, Banayan JM, Rana S, Schnettler WT, Neuburger PJ. Surgical Excision of a Left Atrial Myxoma During the Second Trimester of Pregnancy. J Cardiothorac Vasc Anesth 2019; 34:530-536. [PMID: 31818529 DOI: 10.1053/j.jvca.2019.10.047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2019] [Accepted: 10/28/2019] [Indexed: 11/11/2022]
Affiliation(s)
- John-Henry N Harrison
- Department of Anesthesia and Critical Care, University of Chicago Medical Center, Chicago, IL.
| | - David E Arnolds
- Department of Anesthesia and Critical Care, University of Chicago Medical Center, Chicago, IL
| | - Jennifer M Banayan
- Department of Anesthesia and Critical Care, University of Chicago Medical Center, Chicago, IL
| | - Sarosh Rana
- Department of Obstetrics and Gynecology, University of Chicago Medical Center, Chicago, IL
| | - William T Schnettler
- Division of Maternal-Fetal Medicine, TriHealth: Good Samaritan Hospital, Cincinnati, OH
| | - Peter J Neuburger
- Department of Anesthesiology, Perioperative Care, and Pain Medicine, NYU Langone Health, New York, NY
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11
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Sathananthan G, Johal N, Grewal J. A case report: mechanical tricuspid valve thrombosis necessitating cardiac surgery during pregnancy. EUROPEAN HEART JOURNAL-CASE REPORTS 2019; 3:5509972. [PMID: 31449635 PMCID: PMC6601239 DOI: 10.1093/ehjcr/ytz080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/27/2018] [Revised: 12/12/2018] [Accepted: 05/16/2019] [Indexed: 11/16/2022]
Abstract
Background Pregnant women with mechanical valves are considered a high-risk pregnancy. They carry an increased risk of both maternal and foetal complications. This includes maternal valve thrombosis, foetal embryopathy, and haemorrhage. Cardiac surgery is generally avoided during pregnancy, and is used when there are no other alternative options. Cardiopulmonary bypass (CPB) during pregnancy is associated with high foetal mortality. Maternal mortality in the setting of CPB however, is not dissimilar to a non-pregnant woman. Case summary We present the case of a 29-year-old woman with Ebstein’s anomaly who developed thrombosis of her mechanical tricuspid valve at 4 weeks’ gestation. This was suspected to be likely due to sub-therapeutic anticoagulation at the time of presentation. She underwent a tricuspid valve replacement during the first trimester of pregnancy after failing medical therapy, with overall favourable maternal and foetal outcomes. Discussion Valve thrombosis during pregnancy is a devastating complication. There is limited data surrounding the best management strategy of valve thrombosis in pregnancy. Cardiac surgery with CPB is reserved for cases refractory to appropriate medical therapy. Though maternal mortality is largely unaffected, foetal mortality with CPB remains high. The management of pregnant women undergoing CPB is unique and extremely challenging. It requires a meticulous, multidisciplinary approach to improve overall outcomes.
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Affiliation(s)
- Gnalini Sathananthan
- Department of Cardiology, St. Paul's Hospital, 1081 Burrard St., Vancouver, British Columbia, Canada
| | - Niall Johal
- Department of Cardiology, St. Paul's Hospital, 1081 Burrard St., Vancouver, British Columbia, Canada
| | - Jasmine Grewal
- Department of Cardiology, St. Paul's Hospital, 1081 Burrard St., Vancouver, British Columbia, Canada
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12
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Chengode S, Shabadi RV, Rao RN, Alkemyani N, Alsabti H. Perioperative management of transcatheter, aortic and mitral, double valve-in-valve implantation during pregnancy through left ventricular apical approach. Ann Card Anaesth 2018; 21:185-188. [PMID: 29652282 PMCID: PMC5914221 DOI: 10.4103/aca.aca_157_17] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Pregnant women with stenotic degeneration of bioprosthetic cardiac valves may require another valve replacement procedure when their symptoms deteriorate with progression of pregnancy, but fetal mortality is higher with cardiac surgery done on cardiopulmonary bypass. Transcatheter valve-in-valve implantation may help to improve the fetal and maternal outcomes in these situations. Double valve-in-valve implantation is rare and has not been reported in a pregnant patient. We report, for the first time, the case of a pregnant woman with stenotic bioprosthetic valves in the mitral and aortic positions, who underwent a successful concomitant, transcatheter, double valve-in-valve implantation through the left ventricular apical route during the second trimester of her precious pregnancy.
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Affiliation(s)
- Suresh Chengode
- Department of Anaesthesia, Division of Cardiac Anaesthesia, Sultan Qaboos University Hospital, Muscat, Oman
| | - Rahul Vijaykumar Shabadi
- Department of Anaesthesia, Division of Cardiac Anaesthesia, Sultan Qaboos University Hospital, Muscat, Oman
| | - Ram Narayan Rao
- Department of Anaesthesia, Division of Cardiac Anaesthesia, Sultan Qaboos University Hospital, Muscat, Oman
| | - Nasser Alkemyani
- Department of Anaesthesia, Division of Cardiac Anaesthesia, Sultan Qaboos University Hospital, Muscat, Oman
| | - Hilal Alsabti
- Department of Surgery, Division of Cardiac Surgery, Sultan Qaboos University Hospital, Muscat, Oman
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Patel PA, Fernando RJ, MacKay EJ, Yoon J, Gutsche JT, Patel S, Shah R, Dashiell J, Weiss SJ, Goeddel L, Evans AS, Feinman JW, Augoustides JG. Acute Type A Aortic Dissection in Pregnancy-Diagnostic and Therapeutic Challenges in a Multidisciplinary Setting. J Cardiothorac Vasc Anesth 2018. [PMID: 29519602 DOI: 10.1053/j.jvca.2018.01.035] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Affiliation(s)
- Prakash A Patel
- Cardiovascular and Thoracic Section, Department of Anesthesiology and Critical Care, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Rohesh J Fernando
- Cardiothoracic Section, Department of Anesthesiology, Wake Forest School of Medicine, Wake Forest University, Winston-Salem, NC
| | - Emily J MacKay
- Cardiovascular and Thoracic Section, Department of Anesthesiology and Critical Care, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Jeongae Yoon
- Cardiothoracic Anesthesiology, Department of Anesthesiology, Lewis School of Medicine, Temple University, Philadelphia, PA
| | - Jacob T Gutsche
- Cardiovascular and Thoracic Section, Department of Anesthesiology and Critical Care, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Saumil Patel
- Cardiovascular and Thoracic Section, Department of Anesthesiology and Critical Care, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Ronak Shah
- Cardiovascular and Thoracic Section, Department of Anesthesiology and Critical Care, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Jillian Dashiell
- Cardiovascular and Thoracic Section, Department of Anesthesiology and Critical Care, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Stuart J Weiss
- Cardiovascular and Thoracic Section, Department of Anesthesiology and Critical Care, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Lee Goeddel
- Divisions of Cardiac Anesthesia and Adult Critical Care, Department of Anesthesiology and Critical Care Medicine, School of Medicine, Johns Hopkins University, Baltimore, MD
| | - Adam S Evans
- Department of Anesthesiology, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Jared W Feinman
- Cardiovascular and Thoracic Section, Department of Anesthesiology and Critical Care, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - John G Augoustides
- Cardiovascular and Thoracic Section, Department of Anesthesiology and Critical Care, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA.
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Bazylev VV, Rosseykin EV, Evdokimov ME, Pantyukhina MA. [Valve sparing aortic root replacement (David Procedure) in 36 year - old woman with the Marfan syndrome at the 27th week of pregnancy]. Khirurgiia (Mosk) 2018:75-77. [PMID: 30113598 DOI: 10.17116/hirurgia2018875] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
The article presents a clinical case of valve sparing aortic root replacement (David Procedure) in 36 year - old woman with the Marfan syndrome at the 27th week of gestation followed by successful prolongation of pregnancy. Indications for reconstructive intervention with cardiopulmonary bypass were: severe aortic valve insufficiency, Sinus of Valsalva Aneurysm (66 mm) and the ascending aorta dilatation (53 mm) with a rapid increase of aortic root dimension (12 mm during 9 weeks). The patient underwent a valve sparing aortic root replacement according to David procedure using Gelweave Valsalva graft (Vascutec) No 28 The time of cardiopulmonary bypass was 137 minutes; the time of aortic cross-clamping was 107 minutes. The patient was discharged from the hospital in a satisfactory condition in 21 days after the operation. Pregnancy was prolonged and ended with a planned cesarean section at 38 weeks of gestation, the birth of a boy with an Apgar score of 7/8.
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Affiliation(s)
- V V Bazylev
- Federal Center for Cardiovascular Surgery, Healthcare Ministry of the Russian Federation, Penza, Russia
| | - E V Rosseykin
- Federal Center for Cardiovascular Surgery, Healthcare Ministry of the Russian Federation, Penza, Russia
| | - M E Evdokimov
- Federal Center for Cardiovascular Surgery, Healthcare Ministry of the Russian Federation, Penza, Russia
| | - M A Pantyukhina
- Federal Center for Cardiovascular Surgery, Healthcare Ministry of the Russian Federation, Penza, Russia
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15
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Barrus A, Afshar S, Sani S, LaBounty TG, Padilla C, Farber MK, Rudikoff AG, Hernandez Conte A. Acute Type A Aortic Dissection and Successful Surgical Repair in a Woman at 21 Weeks Gestational Pregnancy With Maternal and Fetal Survival: A Case Report. J Cardiothorac Vasc Anesth 2017; 32:1487-1493. [PMID: 29217246 DOI: 10.1053/j.jvca.2017.09.011] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2017] [Indexed: 02/06/2023]
Affiliation(s)
- Adam Barrus
- Department of Anesthesiology, University of Arizona, Banner University Medical Center, Tucson, AZ
| | - Sam Afshar
- Department of Anesthesiology, University of Arizona, Banner University Medical Center, Tucson, AZ
| | - Sara Sani
- Department of Medicine, University of Arizona, Banner University Medical Center, Tucson, AZ
| | - Troy G LaBounty
- Division of Cardiovascular Medicine, University of Michigan Medical Center, Ann Arbor, MI
| | - Cesar Padilla
- Division of of Obstetric Anesthesia, Department of Anesthesiology, Brigham & Women's Hospital, Boston, MA
| | - Michaela K Farber
- Division of of Obstetric Anesthesia, Department of Anesthesiology, Brigham & Women's Hospital, Boston, MA
| | - Andrew G Rudikoff
- Divisions of Cardiothoracic and Obstetric Anesthesiology, Department of Anesthesiology, Kaiser Permanente Los Angeles Medical Center, Los Angeles, CA
| | - Antonio Hernandez Conte
- Divisions of Cardiothoracic and Obstetric Anesthesiology, Department of Anesthesiology, Kaiser Permanente Los Angeles Medical Center, Los Angeles, CA.
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Left Atrial Myxoma in Pregnancy: Management Strategy Using Minimally Invasive Surgical Approach. Case Rep Cardiol 2017; 2017:8510160. [PMID: 28567309 PMCID: PMC5439244 DOI: 10.1155/2017/8510160] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2017] [Accepted: 04/06/2017] [Indexed: 12/02/2022] Open
Abstract
This case report concerns a young woman who, during her pregnancy, suffered severe mitral regurgitation. It was discovered at the same time that she had a left atrial myxoma. During the early postpartum period she successfully underwent an anterior minithoracotomy to remove the left atrial myxoma in conjunction with repair of the mitral valve. The thoracotomy approach in this specific patient was chosen as it would give a better chance of successful mother-child bonding because the patient would be able to avoid the precautions which would have been necessary following a sternotomy, especially the limitation of her ability to hold her child during the first 4–6 weeks postoperatively.
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Ghanney EC, Cavallo JA, Levin MA, Reddy R, Bander J, Mella M, Stone J, Schwartz M, Haines K, Gidwani U, Mehrazin R. Renal cell carcinoma with inferior vena cava thrombus extending to the right atrium diagnosed during pregnancy. Ther Adv Urol 2017; 9:155-159. [PMID: 28588653 DOI: 10.1177/1756287217701378] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2016] [Accepted: 03/04/2017] [Indexed: 11/15/2022] Open
Abstract
Only one case of renal cell carcinoma (RCC) with inferior vena cava (IVC) tumor thrombus diagnosed and treated during pregnancy has been reported in the literature. In that report, the tumor thrombus extended to the infrahepatic IVC (level II tumor thrombus). In the present case, a 37-year-old woman with lupus anticoagulant antibodies was diagnosed with RCC and IVC tumor thrombus extending to the right atrium (level IV tumor thrombus) at 24 weeks of pregnancy. The fetus was safely delivered by cesarean section at 30 weeks of gestation. At 4 days later, an open right radical nephrectomy and IVC and right atrial thrombectomy were performed on cardiopulmonary bypass (CPB) once the patient's hemodynamic status had been optimized. Fetal and maternal concerns included the risk of a thromboembolic event (due to increased hypercoagulability from pregnancy, active malignancy, and lupus anticoagulant), intraoperative hemorrhage risk (due to extensive venous collaterals and anticoagulation), and fetal morbidity and mortality (due to fetal lung immaturity). Standardized guidelines for treatment of RCC with or without IVC tumor thrombus during pregnancy are unavailable due to the infrequency of such cases. Treatment decisions are therefore individualized and this case report may inform the management of future patients diagnosed with RCC with level IV tumor thrombus during pregnancy.
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Affiliation(s)
- Efe C Ghanney
- Department of Urology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Jaime A Cavallo
- Department of Urology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Matthew A Levin
- Departments of Anesthesiology and Genomics and Genetic Sciences, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Ramachandra Reddy
- Department of Cardiothoracic Surgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Jeffrey Bander
- Division of Cardiology, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Maria Mella
- Department of Obstetrics, Gynecology, and Reproductive Science, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Joanne Stone
- Department of Obstetrics, Gynecology, and Reproductive Science, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Myron Schwartz
- Recanati/Miller Transplantation Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Kenneth Haines
- Department of Pathology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Umesh Gidwani
- Division of Cardiology, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Reza Mehrazin
- Assistant Professor, Department of Urology, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, Box 1272, New York, NY 10029, USA
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Yuan SM. Cardiac myxoma in pregnancy: a comprehensive review. Braz J Cardiovasc Surg 2016; 30:386-94. [PMID: 26313731 PMCID: PMC4541787 DOI: 10.5935/1678-9741.20150012] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2014] [Accepted: 02/16/2015] [Indexed: 12/15/2022] Open
Abstract
OBJECTIVE Cardiac myxoma in pregnancy is rare and the clinical characteristics of this entity have been insufficiently elucidated. This article aims to describe the treatment options and the risk factors responsible for the maternal and feto-neonatal prognoses. METHODS A comprehensive search of the literature of cardiac myxoma in pregnancy was conducted and 44 articles with 51 patients were included in the present review. RESULTS Transthoracic echocardiography was the most common diagnostic tool for the diagnosis of cardiac myxoma during pregnancy. Cardiac myxoma resection was performed in 95.9% (47/49); while no surgical resection was performed in 4.1% (2/49) patients (P=0.000). More patients had an isolated cardiac myxoma resection in comparison to those with a concurrent or staged additional cardiac operation [87.2% (41/47) vs. 12.8% (6/47), P=0.000]. A voluntary termination of the pregnancy was done in 7 (13.7%) cases. In the remaining 31 (60.8%) pregnant patients, cesarean section was the most common delivery mode representing 61.3% and vaginal delivery was more common accounting for 19.4%. Cardiac surgery was performed in the first, second and third trimester in 5 (13.9%), 14 (38.9%) and 17 (47.2%) patients, respectively. No patients died. In the delivery group, 20 (76.9%) neonates were event-free survivals, 4 (15.4%) were complicated and 2 (7.7%) died. Neonatal prognoses did not differ between the delivery modes, treatment options, timing of cardiac surgery and sequence of cardiac myxoma resection in relation to delivery. CONCLUSION The diagnosis of cardiac myxoma in pregnancy is important. Surgical treatment of cardiac myxoma in the pregnant patients has brought about favorable maternal and feto-neonatal outcomes in the delivery group, which might be attributable to the shorter operation duration and non-emergency nature of the surgical intervention. Proper timing of cardiac surgery and improved cardiopulmonary bypass conditions may result in even better maternal and feto-neonatal survivals.
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Affiliation(s)
- Shi-Min Yuan
- The First Hospital of Putian, Teaching Hospital, Fujian Medical University, Putian, Fujian Province, CN
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Saito A. Editorial: Pregnant patients and open-heart surgery - Decision-making for appropriate timing and surgical strategy. J Cardiol Cases 2016; 13:70-71. [PMID: 30546608 PMCID: PMC6280683 DOI: 10.1016/j.jccase.2015.12.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2015] [Indexed: 10/22/2022] Open
Affiliation(s)
- Aya Saito
- Division of Cardiovascular Surgery, Toho University Sakura Medical Center, Sakura, Chiba, Japan
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