Cardiopulmonary bypass during pregnancy

Area of Science:

• Cardiology
• Maternal-Fetal Medicine
• Cardiovascular Surgery

Background:

• Heart disease in pregnancy affects 1.5% of cases.
• Cardiac operations during pregnancy carry significant risks, with high fetal mortality (19%) despite similar maternal risk (3%) to non-pregnant patients.
• Teratogenesis risk is high in the first two trimesters, making cardiac operations generally ill-advised.

Purpose of the Study:

• To review the risks and management strategies for cardiac operations during pregnancy.
• To discuss the impact of cardiopulmonary bypass on maternal and fetal outcomes.
• To highlight essential monitoring and potential interventions for managing pregnant patients undergoing cardiac surgery.

Main Methods:

• Review of existing literature on cardiac operations in pregnant patients.
• Analysis of maternal and fetal outcomes associated with cardiopulmonary bypass.
• Discussion of fetal and fetoplacental unit responses to cardiopulmonary bypass.

Main Results:

• Cardiac operations in the third trimester may involve delivery before cardiopulmonary bypass, or using normothermic bypass briefly.
• Fetal bradycardia during bypass is linked to hypoperfusion and uterine contractions, reversible by increasing perfusion.
• Fetoplacental unit response includes vasoactive and acidosis components, potentially related to stress response.

Conclusions:

• Cardiac operations during pregnancy require careful consideration of gestational timing and management strategies.
• Fetal heart rate and uterine monitoring are crucial during cardiopulmonary bypass in pregnant patients.
• Further research is needed to optimize cardiopulmonary bypass techniques and interventions for pregnant women.