Cardiac Surgery in Pregnancy

Yıl 2011, Cilt: 14 Sayı: 3, 96 - 100, 01.03.2010

Cenk Eray Yıldız

Öz

Cardiovascular applications during pregnancy can be tolerated among pregnant women. However, about 2-4% of women at gestational age have concomitant heart disease. A few of these patients may undergo corrective surgery. In this state, maternal mortality rates are improved so that the rates will be similar to that of non-pregnant patients undergoing the same treatment. However fetal mortality rates are high (35%). The factors that lead to high fetal mortality are the timing of operation, emergency of the operation and fetal/fetoplacental response towards cardiopulmonary bypass. The adjustment of this response may prevent placental dysfunction and uterin contractions. These contractions are the main reason of hypoxia and acidosis. In this article, cardiovascular applications during pregnacy and the effects of cardiovascular bypass on the mother, fetus and fetoplacental unit have been discussed and also manipulations of these responses whether improved the fetal outcome. As a result, perfusion management and off-pump cardiac surgical techniques during pregnancy have been assessed.

Anahtar Kelimeler

Cardiac surgery, cardiopulmonary bypass, pregnancy.

Gebelikte Kalp Cerrahisi

Öz

Gebelikteki kardiyovasküler girişimler, sağlıklı kadınlarda tolere edilebilir fakat doğurganlık yaşındaki kadınların %2-4'ünde eşlik eden kalp hastalığı vardır. Bu gruptaki hastaların tedaviye cevap vermeyen bir bölümü cerrahi düzeltmeye maruz kalır. Son zamanlarda, maternal mortalite oranları, hamile olmayan hastalardaki seviyelere benzer şekilde iyileştirilmiştir. Fakat fetal mortalite oranı hala yüksek seviyelerdedir (%35). Yüksek fetal mortalite oranına sebep olan faktörler; operasyonun süresi, operasyonun aciliyeti ve kardiyopulmoner baypasa fetal/fetoplasental cevaptır. Bu cevabın değişimi plasental disfonksiyonu ve uterin kasılmalarını önleyebilir. Bu kasılmalar, hipoksi ve asit zehirlenmesinin temelini oluşturur. Bu yazıda, hamilelikteki kardiyovasküler problemler ve kardiyovasküler baypasın anne, fetüs ve fetoplasental birimdeki etkileri üzerinde durulmuştur. Bu cevapların manüplasyonunun fetal sonlanıma neden olup olmadığına değinilmiştir. Sonuç olarak, perfüzyon yönetimi ve hamilelikte pompasız kardiyak cerrahi tekniklerin yaklaşımları değerlendirilmiştir.

Anahtar Kelimeler

Kalp cerrahisi, kardiyopulmoner baypas, gebelik.

Kaynakça

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