Calcification of a porcine valve xenograft during pregnancy--a case report and review of the literature

Outcome of cardiovascular surgery and pregnancy: a systematic review of the period 1984-1996

The outcomes of cardiovascular operations during pregnancy, at delivery, and post partum were reviewed from published material in the period 1984-1996. Surgery during pregnancy resulted in fetal-neonatal morbidity and mortality of 9% and 30%, respectively, and in maternal morbidity and mortality of 24% and 6%, respectively. Duration of pregnancy at surgery and duration and temperature of cardiopulmonary bypass did not influence fetal-neonatal outcome. Maternal complications and mortality of surgery immediately after delivery were 29% and 12%, respectively, and for surgery performed with a postpartum interval the respective rates were 38% and 14%. Hospitalization after week 27 of gestation and extreme emergency contributed significantly to poor maternal outcome. Maternal deaths were reported in 9% of valvular procedures and in 22% of aortic or arterial dissection repairs and pulmonary embolectomies. Fetal-neonatal risks of maternal surgery during pregnancy are high and unpredictable. Maternal risks of cardiovascular procedures during pregnancy are moderate, significantly increase if an operation is performed at or after delivery, and, overall, should be considered as higher than those in nonpregnant cardiovascular surgical patients.

[Maternal mortality due to heart disease]

A retrospective study on maternal mortality in pregnant women with cardiac disease over a period of eleven years (January 1979 to December 1989) was undertaken. The objective was an analysis of the main aspects of this association. Cardiac disease was diagnosed in 694 patients (4.2%) of a total of 16,423 admitted to the Obstetrics Department of the Escola Paulista de Medicina. As for etiology, rheumatic disease (52.3%); Chagas's disease (19.3%) and congenital disease (8.1%) were the most frequent causes. There were 51 maternal deaths, according to FIGO's definition (1967), corresponding to a maternal mortality rate of 428.2/100,000 livebirths during the same period. Twelve of these maternal deaths were due to cardiac disease (maternal mortality rate of 100.8/100,000 livebirths). The statistical analysis identified the following aspects associated with maternal mortality among patients with cardiac disease: primigravida, lack of adequate prenatal care, and cardiac surgery performed previously to and/or during pregnancy. Congestive heart failure with pulmonary edema (41.7%) and thromboembolism (25.0%) were the most frequent causes of maternal death among patients with cardiac disease. The NYHA functional classification was not a good parameter for pregnancy prognosis: eleven patients (91.7%) were considered as belonging to the favorable group before they became pregnant. Most maternal deaths occurred during the first 72 hours after delivery. Therefore, this period was considered most critical for maternal mortality in patients with cardiac disease. No relation-ship was found among the factors: maternal age, race, marital status, delivery and maternal mortality among patients with cardiac disease.(ABSTRACT TRUNCATED AT 250 WORDS)