Malformaçäo cerebral do concepto associada à endocardite infecciosa materna e à substituiçäo da valva aórtica durante a gestaçäo / Congenital malformation of the brainassociated to aortic valve replacement in pregnant woman with bacterialendocarditis

RESUMO

Paciente de 23 anos de idade, sem história de cardiopatia, desenvolveu endocardite com hemoculturas negativas no 2§ trimestre da 3§ gestaçäoHouve controle da febre com antibioticoterapia, contudo evoluiu com insuficiência cardíaca congestiva conseqüente a insuficicência aórtica grave, tendo sido submetida a substituiçäo de valva aórtica por bioprótese de pericárdio bovino. O período pós-operatório transcorreu sem intercorrências, com alta hospitalar no 42§ dia de internaçäo. Na 39§ semana da gestaçäo, ocorreu parto do tipo cesáreo, sem complicaçöes, inclusive no puerpério. O recém-nascido (apgar 5 no 1§ minuto e 7 no 2§ minuto) apresentou sinais de comprometimento neurológico, caracterizado, a través de tomografia computadorizada no 2§ mês de vida, como decorrente de atrofia cerebral de ocorrência estimada no 2§ trimestre da gestaçäo. Entre as diversas causas possíveis de malformaçäo cerebral, sobressai a influência da circulaçäo extracorpórea

ABSTRACT

A twenty-three years old woman, without previous heart disease developed endocarditis with negative bloods cultures on the fourth month of her third pregnacy. Fever was controlled through antibiotics, however she developed cardiac insufficiency and was submitted to surgery for replacement of aortic valve with a bioprothesis. The post operative period showed no problems and the patient was discharged on the forty second day after admission. On the thirty nineth week of pregnancy she gave cesarean birth, without complications. The newly born, apgar 5 (I min.) and 7 (5 min) presented signs of neurological problems, characterized on the second month as a cerebral atrophy. Among various possible factors, the most likely would be cardiopulmonary bypass circulation as the maior of the neurological malformation.