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Coronary artery bypass surgery during pregnancy
S Silberman1, D Fink, R S Berko
1Department of Cardio-thoracie Surgery, Shaare Zedek Medical Center, Jerusalem, Israel.
Summary
This study reports a successful emergency coronary artery bypass grafting surgery on a pregnant woman with acute myocardial infarction. The innovative on-pump technique ensured a healthy mother and baby, avoiding cardiopulmonary bypass risks.
Area of Science:
- Cardiology
- Cardiothoracic Surgery
- Maternal-Fetal Medicine
Background:
- Acute myocardial infarction and intractable angina during pregnancy pose significant risks.
- Spontaneous coronary artery dissection is a rare but serious complication.
- Surgical intervention for coronary artery disease in pregnant patients requires careful consideration of fetal safety.
Observation:
- A 32-year-old pregnant woman at 22 weeks gestation presented with acute myocardial infarction and persistent angina.
- Cardiac catheterization identified spontaneous dissection of the left anterior descending artery (LAD).
- Emergency coronary artery bypass grafting (CABG) to the LAD was performed.
Findings:
- The CABG procedure utilized the left internal mammary artery and was performed on a beating heart, avoiding cardiopulmonary bypass.
- The patient experienced an uneventful recovery.
- Fetal well-being was maintained throughout the perioperative period, confirmed by ultrasound and pulse monitoring.
- The patient delivered a healthy, full-term baby.
Implications:
- This case demonstrates the feasibility and safety of on-pump CABG in pregnant patients, particularly when cardiopulmonary bypass is a concern.
- The successful surgical approach highlights a potential strategy to manage acute coronary syndromes in pregnancy, safeguarding both maternal and fetal outcomes.
- This represents a significant advancement in managing complex cardiac conditions during gestation, offering a viable alternative to medical management alone.