Manisha Mishra1, Ravindra Sawhney1, Anil Kumar1, Kumar Ramesh Bapna2, Vijay Kohli2, Harpreet Wasir2, Naresh Trehan2
1 Department of Cardiaothoracic and Vascular Anesthesiology, Medanta The Medicity, Gurgaon, Haryana, India
2 Department of Cardiaothoracic and Vascular Surgery, Medanta The Medicity, Gurgaon, Haryana, India
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.
D-2, Front Portion, SF, Kalindi Colony, New Delhi-110065
Source of Support: None, Conflict of Interest: None
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