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Ann Card Anaesth ; 2014 Jan; 17(1): 46-51
Article Dans Anglais | IMSEAR | ID: sea-149693

Résumé

The fetal death rate associated with cardiac surgery with cardiopulmonary bypass (CPB) is as high as 9.5‑29%. We report continuous monitoring of fetal heart rate and umbilical artery flow‑velocity waveforms by transvaginal ultrasonography and their analyses in relation to events of the CPB in two cases in second trimester of pregnancy undergoing mitral valve replacement. Our findings suggest that the transition of circulation from corporeal to extracorporeal is the most important event during surgery; the associated decrease in mean arterial pressure (MAP) at this stage potentially has deleterious effects on the fetus, which get aggravated with the use of vasopressors. We suggest careful management of CPB at this stage, which include partial controlled CPB at initiation and gradual transition to full CPB; this strategy maintains high MAP and avoids the use of vasopressors. Maternal and fetal monitoring can timely recognize the potential problems and provide window for the required treatment.


Sujets)
Adulte , Pression artérielle/physiologie , Auricule de l'atrium/imagerie diagnostique , Procédures de chirurgie cardiaque/méthodes , Pontage cardiopulmonaire , Femelle , Surveillance de l'activité foetale/méthodes , Rythme cardiaque/physiologie , Rythme cardiaque foetal , Implantation de valve prothétique cardiaque , Humains , Fluxmétrie laser Doppler , Insuffisance mitrale/chirurgie , Sténose mitrale/chirurgie , Grossesse/physiologie , Issue de la grossesse , Résultat thérapeutique , Sténose tricuspidienne/imagerie diagnostique , Artères ombilicales/physiologie , Artères ombilicales/imagerie diagnostique
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