Cardiopulmonary bypass in pregnancy

Abstract

Cardiac surgery carried out on cardiopulmonary bypass (CPB) in a pregnant woman is associated with poor neonatal outcomes although maternal outcomes are similar to cardiac surgery in non-pregnant women. Most adverse maternal and fetal outcomes from cardiac surgery during pregnancy are attributed to effects of CPB. The CPB is associated with utero-placental hypoperfusion due to a number of factors, which may translate into low fetal cardiac output, hypoxia and even death. Better maternal and fetal outcomes may be achieved by early pre-operative optimization of maternal cardiovascular status, use of perioperative fetal monitoring, optimization of CPB, delivery of a viable fetus before the operation and scheduling cardiac surgery on an elective basis during the second trimester.

Keywords

• Cardiac output; Cardiac surgery; Pharmacodynamics; Sevoflurane
• Bidirectional Glenn procedure; Continuous positive airway pressure; Pressure support ventilation; Intermittent positive-pressure ventilation; Synchronized intermittent mandatory ventilation
• General anesthesia; MitraClip; Mitral regurgitation; Transesophageal echocardiography
• Cardiac surgery; Congenital; Monitoring; Neurological
• Cardiac surgery
• Cardiopulmonary bypass
• Fetal outcomes
• Maternal outcomes
• Pregnancy
• Uteroplacental perfusion