DEPT. OF CARDIOTHORACIC SURGERY, SHAHEED RAJAEE CARDIOVASCULAR MEDICAL CENTER, MELLAT PARK, VALI ASR AVE., TEHRAN, IRAN
Introduction: Cardiopathy still remains a prominent cause of maternal and fetal morbidity and mortality. Pregnancy increases cardiovascular stress and can cause an asymptomatic woman with heart disease to become symptomatic. Definite data in heart surgery with extracorporeal circulation during pregnancy are limited. This report analyzes our experience in this area.
Methods: Thirteen women who underwent open-heart surgery during pregnancy at our center in Tehran from 1985 to 2002 were studied. The patients were in New York Heart Association functional class III to IV and were operated upon urgently.
Results: The mean age of the women at the time of surgery was 25.3±5.41 years (range: 17- 36 years). Their gestational age was 4-32 weeks. Surgical procedures performed were mitral valve replacement for mitral stenosis in 4 (30.76%) patients, declotting or redo valve replacement for prosthetic valve malfunction in 7 (53.83%), excision of subvalvular aortic stenosis in 1 (7.69%) and resection of atrial myxoma in 1 (7.69%) patient. Surgery was performed at normothermic cardiopulmonary bypass in 8 patients and mild hypothermia in 5 patients. There was one maternal death and as a result, fetal loss. Fetal deaths occurred in 5 of the 12 pregnancies (41.6%) in the women who survived the surgical procedure.
Conclusion: Cardiopulmonary bypass during pregnancy carries a high risk of fetal morbidity and mortality and should be advised only in extreme emergencies. If possible, surgery should be carried out in the second trimester of pregnancy.