Lessons Learned From Three Patients Who Underwent Cesarean Section and Cardiac Valvular Surgery Simultaneously: Anesthesiologists’ Perspective

Yıl 2024, , 36 - 43, 25.03.2024

Alpin Tamay Finci Nevin Aydın

https://doi.org/10.46969/EZH.1377297

Öz

Background: Cardiac valvular disease constitutes a challenge during pregnancy. Herein, we present our experience with three patients who underwent caesarean section and cardiac valvular surgery simultaneously. The purpose of this case series was to outline the clinical characteristics and to highlight the surgical/anesthesiologic pitfalls to be considered in patients who will undergo cardiac valvular surgery and caesarean section simultaneously.
Methods: This retrospective case series was implemented using data extracted from the medical files of three patients who underwent cardiac valvular surgery and caesarean section in the obstetrics and gynecology and cardiovascular surgery departments of our tertiary care center. Demographic data, history, echocardiographic findings, surgical and anesthesiologic techniques as well as perioperative information and therapeutic outcomes were recorded.
Results: Three pregnant women with an average age of 33.67 years were diagnosed with various cardiac valvular pathologies on the 3rd trimester. Owing to their diminished cardiac reserves and clear indications for cesarean section, the patients underwent cardiac valvular surgery subsequent to the cesarean section. Procedures were completed successfully on all patients and mothers and infants were discharged after a maternal follow-up in intensive care unit.
Conclusion: We suggest that cardiac valve surgery can be performed simultaneously just after cesarean section in selected cases. Risks and benefits must be analyzed well prior to the decision making for the absolute necessity of the invasive procedure. Close collaboration between disciplines, well equipped referral centers, trained personnel and increased awareness on possible complications are the key points for successful surgical management of pregnant women with cardiac valve disease.

Anahtar Kelimeler

Cardiac valvular disease, surgery, pregnancy, cesarean section, anesthesia

Eş Zamanlı Sezaryen ve Kalp Kapak Ameliyatı Geçiren Üç Hastadan Öğrenilen Dersler: Anestezistlerin Bakış Açısı

Öz

Amaç: Kalp kapak hastalıkları gebelik sırasında önemli bir sorundur. Burada eş zamanlı olarak sezaryen ve kalp kapağı ameliyatı geçiren üç hastayla ilgili deneyimimizi sunuyoruz. Bu vaka serisinin amacı, eş zamanlı olarak kalp kapağı cerrahisi ve sezaryen operasyonu geçirecek hastalarda klinik özelliklerin ana hatlarını çizmek ve dikkate alınması gereken cerrahi/anesteziyolojik durumları vurgulamaktı.
Yöntem: Bu retrospektif vaka serisi, üçüncü basamak merkezimizin kadın hastalıkları ve doğum ve kalp damar cerrahisi bölümlerinde kalp kapak cerrahisi ve sezaryen operasyonu geçiren üç hastanın tıbbi dosyalarından elde edilen veriler kullanılarak uygulandı. Demografik veriler, öykü, ekokardiyografik bulgular, cerrahi ve anestezi teknikleri ile perioperatif bilgiler ve tedavi sonuçları kaydedildi.
Bulgular: Yaş ortalaması 33,67 olan üç gebeye 3. trimesterde çeşitli kalp kapak patolojileri tanısı konuldu. Kalp rezervlerinin azalması ve sezaryen endikasyonunun net olması nedeniyle hastalara sezaryen sonrası kalp kapağı ameliyatı uygulandı. Tüm hastaların işlemleri başarıyla tamamlandı ve anne ile bebekleri yoğun bakımda takibinin ardından taburcu edildi.
Sonuç: Seçilmiş olgularda sezaryen sonrası eş zamanlı olarak kalp kapak cerrahisinin yapılabileceğini düşünüyoruz. İnvaziv işlemin mutlak gerekliliği için karar vermeden önce riskler ve faydalar iyi analiz edilmelidir. Disiplinler arası yakın işbirliği, iyi donanımlı sevk merkezleri, eğitimli personel ve olası komplikasyonlar konusunda artan farkındalık, kalp kapak hastalığı olan hamile kadınların başarılı cerrahi tedavisinin kilit noktalarıdır.

Anahtar Kelimeler

Kalp kapak hastalığı, ameliyat, gebelik, sezaryen, anestezi

Kaynakça

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