Continuous Cardiac Doppler of the Fetus Guiding an Aortic Valve Replacement in an Eighteen Weeks Pregnant Woman with Active Endocarditis

Nadine Kawkabani; Roula Darwish; Moussa Abi Ghanem; Simon Bejjani; Omar Boustros; Rawad Halimeh; Joe Khalifeh; Assaad Maalouf; Bassam Abou Khalil; Elie Anastasiades

doi:doi:10.11648/j.ijcts.20190501.15

Continuous Cardiac Doppler of the Fetus Guiding an Aortic Valve Replacement in an Eighteen Weeks Pregnant Woman with Active Endocarditis

Nadine Kawkabani, Roula Darwish, Moussa Abi Ghanem, Simon Bejjani, Omar Boustros, Rawad Halimeh, Joe Khalifeh, Assaad Maalouf, Bassam Abou Khalil, Elie Anastasiades

Published in International Journal of Cardiovascular and Thoracic Surgery (Volume 5, Issue 1)

Received: 8 February 2019 Accepted: 19 March 2019 Published: 15 May 2019

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Abstract

Two percent of pregnant women experience some type of cardiac pathologic disease. In some cases surgery becomes mandatory to save the mother’s life. The maternal mortality rate in pregnant women undergoing open heart procedures is around 2.9% while the fetal mortality rate ranges between 9.5 to 29%. Many papers have advanced measures in order to decrease fetal morbidity and mortality such as tepid to normothermic cardiopulmonary bypass, good oxygenation, high hematocrit, pulsatile flow, alpha stat management, mean arterial pressure around 70mmhg and a pump flow above 2.4l/min. They recommend also a close monitoring of the fetal heart rate, uteroplacental blood flow and uterine contractions We report in this paper, the case of a 26 year old pregnant female who underwent at 18 weeks an aortic valve replacement. Severe fetal bradycardia occurred 30 min after going on bypass lasted for 20 min and was refractory to a further increase in pump flow, mean arterial pressure and hematocrit. The fetal heart rate returned to its baseline only after rewarming the patient to 35.5 degrees Celsius. The post-operative course was uneventful and a close follow up revealed a normal fetal status. At 38 weeks the mother delivered a healthy normal baby girl. Since fetal bradycardia occurred despite respecting all the recommendations and only reversed after rewarming the mother to 35.5 degrees Celsius, we would suggest not lowering the temperature during cardiopulmonary bypass below 35.5 degrees in pregnant patients undergoing cardiac procedures. Thus more reports and papers are mandatory in order to further elucidate the factors responsible of the adverse events that occur in such cases.

Published in	International Journal of Cardiovascular and Thoracic Surgery (Volume 5, Issue 1)
DOI	10.11648/j.ijcts.20190501.15
Page(s)	21-25
Creative Commons	This is an Open Access article, distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution and reproduction in any medium or format, provided the original work is properly cited.
Copyright	Copyright © The Author(s), 2019. Published by Science Publishing Group

Keywords

Pregnant Woman, Cardiac Surgery, Fetal Bradycardia, Continuous Fetal Cardiac Doppler

References

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[2]	Goldstein I, Jakobi P, Gutterman E et al. Umbilical artery flow velocity during maternal cardiopulmpnary by pass. Ann thoracsurg 1995; 60: 1116-1118.
[3]	Mishra M, Sauhney R, Kumar A et al. Cardiac surgery during pregnancy: continuous fetal monitoring using umbilical artery Doppler flow velocity indices. Annals of cardiac anesthesia, 2014; 17: 46-51.
[4]	Drenthen W, Pieper PG, Roos-Hesselink JW, van Lottum WA, Voors AA, Mulder BJ, et al. Outcome of pregnancy in women with congenital heart disease: A literature review. J Am Coll Cardiol 2007; 49: 2303-11.
[5]	Patel A, Asopa S, Tang AT, Ohri SK. Cardiac surgery during pregnancy. Tex Heart Inst J 2008; 35: 307-12.
[6]	Chandrasekhar S, Cook CR, Collard CD. Cardiac surgery in the parturient. Anesth Analg 2009; 108: 777-85.
[7]	Farmakides G, Shulman H, Mohtashmi M et al. Uterine umbilical velocimetry in open heart surgery. Am J obstet Gynecol 1987; 156: 1221-1222.
[8]	Arnoni R, Antoninho S Arnoni A et al. Risk factors associated with cardiac surgery during pregnancy. Ann thorac surg 2003; 76: 1605-1608.
[9]	Lamb MP, Ross KJ Jhonstone AM et al. Fetal heart monitoring during open heart surgery. Br J obstet Gynaecol 1981; 88: 669-674.
[10]	Werch A Lambert AM. Fetal monitoring and maternal open heart surgery. South med 1977; 70: 1024-1026.
[11]	Kawkabani N, Kawas N, Baraka A et al. Severevfetal bradycardia in a pregnant woman undergoing hypothermic cardiopulmonary bypass. Journal of cardiothoracic and vascular anesthesia 1999; 13: 346-349.
[12]	Bendamkaddem S, Berdai A, Labib S et al. A historic case of cardiac surgery in pregnancy. case reports in obstetrics and gynecology. 2016: 1-4.
[13]	Roussow GJ, Knott Craig CI, Bernard Pm et al. Intracardiac operation in seru pregnant women. Ann Thorac Surg 1993; 55: 1172-1174.
[14]	Chambers CE, Clark SL. Cardiac surgery during pregnancy. Cilin obst Gynecol 1996; 37: 316-323.

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APA Style

Nadine Kawkabani, Roula Darwish, Moussa Abi Ghanem, Simon Bejjani, Omar Boustros, et al. (2019). Continuous Cardiac Doppler of the Fetus Guiding an Aortic Valve Replacement in an Eighteen Weeks Pregnant Woman with Active Endocarditis. International Journal of Cardiovascular and Thoracic Surgery, 5(1), 21-25. https://doi.org/10.11648/j.ijcts.20190501.15

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ACS Style

Nadine Kawkabani; Roula Darwish; Moussa Abi Ghanem; Simon Bejjani; Omar Boustros, et al. Continuous Cardiac Doppler of the Fetus Guiding an Aortic Valve Replacement in an Eighteen Weeks Pregnant Woman with Active Endocarditis. Int. J. Cardiovasc. Thorac. Surg. 2019, 5(1), 21-25. doi: 10.11648/j.ijcts.20190501.15

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AMA Style

Nadine Kawkabani, Roula Darwish, Moussa Abi Ghanem, Simon Bejjani, Omar Boustros, et al. Continuous Cardiac Doppler of the Fetus Guiding an Aortic Valve Replacement in an Eighteen Weeks Pregnant Woman with Active Endocarditis. Int J Cardiovasc Thorac Surg. 2019;5(1):21-25. doi: 10.11648/j.ijcts.20190501.15

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@article{10.11648/j.ijcts.20190501.15,
  author = {Nadine Kawkabani and Roula Darwish and Moussa Abi Ghanem and Simon Bejjani and Omar Boustros and Rawad Halimeh and Joe Khalifeh and Assaad Maalouf and Bassam Abou Khalil and Elie Anastasiades},
  title = {Continuous Cardiac Doppler of the Fetus Guiding an Aortic Valve Replacement in an Eighteen Weeks Pregnant Woman with Active Endocarditis},
  journal = {International Journal of Cardiovascular and Thoracic Surgery},
  volume = {5},
  number = {1},
  pages = {21-25},
  doi = {10.11648/j.ijcts.20190501.15},
  url = {https://doi.org/10.11648/j.ijcts.20190501.15},
  eprint = {https://article.sciencepublishinggroup.com/pdf/10.11648.j.ijcts.20190501.15},
  abstract = {Two percent of pregnant women experience some type of cardiac pathologic disease. In some cases surgery becomes mandatory to save the mother’s life. The maternal mortality rate in pregnant women undergoing open heart procedures is around 2.9% while the fetal mortality rate ranges between 9.5 to 29%. Many papers have advanced measures in order to decrease fetal morbidity and mortality such as tepid to normothermic cardiopulmonary bypass, good oxygenation, high hematocrit, pulsatile flow, alpha stat management, mean arterial pressure around 70mmhg and a pump flow above 2.4l/min. They recommend also a close monitoring of the fetal heart rate, uteroplacental blood flow and uterine contractions We report in this paper, the case of a 26 year old pregnant female who underwent at 18 weeks an aortic valve replacement. Severe fetal bradycardia occurred 30 min after going on bypass lasted for 20 min and was refractory to a further increase in pump flow, mean arterial pressure and hematocrit. The fetal heart rate returned to its baseline only after rewarming the patient to 35.5 degrees Celsius. The post-operative course was uneventful and a close follow up revealed a normal fetal status. At 38 weeks the mother delivered a healthy normal baby girl. Since fetal bradycardia occurred despite respecting all the recommendations and only reversed after rewarming the mother to 35.5 degrees Celsius, we would suggest not lowering the temperature during cardiopulmonary bypass below 35.5 degrees in pregnant patients undergoing cardiac procedures. Thus more reports and papers are mandatory in order to further elucidate the factors responsible of the adverse events that occur in such cases.},
 year = {2019}
}

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TY  - JOUR
T1  - Continuous Cardiac Doppler of the Fetus Guiding an Aortic Valve Replacement in an Eighteen Weeks Pregnant Woman with Active Endocarditis
AU  - Nadine Kawkabani
AU  - Roula Darwish
AU  - Moussa Abi Ghanem
AU  - Simon Bejjani
AU  - Omar Boustros
AU  - Rawad Halimeh
AU  - Joe Khalifeh
AU  - Assaad Maalouf
AU  - Bassam Abou Khalil
AU  - Elie Anastasiades
Y1  - 2019/05/15
PY  - 2019
N1  - https://doi.org/10.11648/j.ijcts.20190501.15
DO  - 10.11648/j.ijcts.20190501.15
T2  - International Journal of Cardiovascular and Thoracic Surgery
JF  - International Journal of Cardiovascular and Thoracic Surgery
JO  - International Journal of Cardiovascular and Thoracic Surgery
SP  - 21
EP  - 25
PB  - Science Publishing Group
SN  - 2575-4882
UR  - https://doi.org/10.11648/j.ijcts.20190501.15
AB  - Two percent of pregnant women experience some type of cardiac pathologic disease. In some cases surgery becomes mandatory to save the mother’s life. The maternal mortality rate in pregnant women undergoing open heart procedures is around 2.9% while the fetal mortality rate ranges between 9.5 to 29%. Many papers have advanced measures in order to decrease fetal morbidity and mortality such as tepid to normothermic cardiopulmonary bypass, good oxygenation, high hematocrit, pulsatile flow, alpha stat management, mean arterial pressure around 70mmhg and a pump flow above 2.4l/min. They recommend also a close monitoring of the fetal heart rate, uteroplacental blood flow and uterine contractions We report in this paper, the case of a 26 year old pregnant female who underwent at 18 weeks an aortic valve replacement. Severe fetal bradycardia occurred 30 min after going on bypass lasted for 20 min and was refractory to a further increase in pump flow, mean arterial pressure and hematocrit. The fetal heart rate returned to its baseline only after rewarming the patient to 35.5 degrees Celsius. The post-operative course was uneventful and a close follow up revealed a normal fetal status. At 38 weeks the mother delivered a healthy normal baby girl. Since fetal bradycardia occurred despite respecting all the recommendations and only reversed after rewarming the mother to 35.5 degrees Celsius, we would suggest not lowering the temperature during cardiopulmonary bypass below 35.5 degrees in pregnant patients undergoing cardiac procedures. Thus more reports and papers are mandatory in order to further elucidate the factors responsible of the adverse events that occur in such cases.
VL  - 5
IS  - 1
ER  -

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Author Information

Nadine Kawkabani

Department of Cardiac Anesthesia, Saint George Hospital-University Medical Center, University of Balamand, Beirut, Lebanon
Roula Darwish

Department of Cardiac Anesthesia, Saint George Hospital-University Medical Center, University of Balamand, Beirut, Lebanon
Moussa Abi Ghanem

Department of Cardiothoracic Surgery, Saint George Hospital-University Medical Center, University of Balamand, Beirut, Lebanon
Simon Bejjani

Department of Cardiothoracic Surgery, Saint George Hospital-University Medical Center, University of Balamand, Beirut, Lebanon
Omar Boustros

Department of Cardiothoracic Surgery, Saint George Hospital-University Medical Center, University of Balamand, Beirut, Lebanon
Rawad Halimeh

Department of Obstetrics-Gynecology-Foetal Maternal Division, Saint George Hospital-Medical Center-University, University of Balamand, Beirut, Lebanon
Joe Khalifeh

Department of Obstetrics-Gynecology-Foetal Maternal Division, Saint George Hospital-Medical Center-University, University of Balamand, Beirut, Lebanon
Assaad Maalouf

Department of Cardiology, Saint George Hospital-University Medical Center, University of Balamand, Beirut, Lebanon
Bassam Abou Khalil

Department of Cardiothoracic Surgery, Saint George Hospital-University Medical Center, University of Balamand, Beirut, Lebanon
Elie Anastasiades

Department of Obstetrics-Gynecology-Foetal Maternal Division, Saint George Hospital-Medical Center-University, University of Balamand, Beirut, Lebanon

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APA Style

Nadine Kawkabani, Roula Darwish, Moussa Abi Ghanem, Simon Bejjani, Omar Boustros, et al. (2019). Continuous Cardiac Doppler of the Fetus Guiding an Aortic Valve Replacement in an Eighteen Weeks Pregnant Woman with Active Endocarditis. International Journal of Cardiovascular and Thoracic Surgery, 5(1), 21-25. https://doi.org/10.11648/j.ijcts.20190501.15

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ACS Style

Nadine Kawkabani; Roula Darwish; Moussa Abi Ghanem; Simon Bejjani; Omar Boustros, et al. Continuous Cardiac Doppler of the Fetus Guiding an Aortic Valve Replacement in an Eighteen Weeks Pregnant Woman with Active Endocarditis. Int. J. Cardiovasc. Thorac. Surg. 2019, 5(1), 21-25. doi: 10.11648/j.ijcts.20190501.15

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AMA Style

Nadine Kawkabani, Roula Darwish, Moussa Abi Ghanem, Simon Bejjani, Omar Boustros, et al. Continuous Cardiac Doppler of the Fetus Guiding an Aortic Valve Replacement in an Eighteen Weeks Pregnant Woman with Active Endocarditis. Int J Cardiovasc Thorac Surg. 2019;5(1):21-25. doi: 10.11648/j.ijcts.20190501.15

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@article{10.11648/j.ijcts.20190501.15,
  author = {Nadine Kawkabani and Roula Darwish and Moussa Abi Ghanem and Simon Bejjani and Omar Boustros and Rawad Halimeh and Joe Khalifeh and Assaad Maalouf and Bassam Abou Khalil and Elie Anastasiades},
  title = {Continuous Cardiac Doppler of the Fetus Guiding an Aortic Valve Replacement in an Eighteen Weeks Pregnant Woman with Active Endocarditis},
  journal = {International Journal of Cardiovascular and Thoracic Surgery},
  volume = {5},
  number = {1},
  pages = {21-25},
  doi = {10.11648/j.ijcts.20190501.15},
  url = {https://doi.org/10.11648/j.ijcts.20190501.15},
  eprint = {https://article.sciencepublishinggroup.com/pdf/10.11648.j.ijcts.20190501.15},
  abstract = {Two percent of pregnant women experience some type of cardiac pathologic disease. In some cases surgery becomes mandatory to save the mother’s life. The maternal mortality rate in pregnant women undergoing open heart procedures is around 2.9% while the fetal mortality rate ranges between 9.5 to 29%. Many papers have advanced measures in order to decrease fetal morbidity and mortality such as tepid to normothermic cardiopulmonary bypass, good oxygenation, high hematocrit, pulsatile flow, alpha stat management, mean arterial pressure around 70mmhg and a pump flow above 2.4l/min. They recommend also a close monitoring of the fetal heart rate, uteroplacental blood flow and uterine contractions We report in this paper, the case of a 26 year old pregnant female who underwent at 18 weeks an aortic valve replacement. Severe fetal bradycardia occurred 30 min after going on bypass lasted for 20 min and was refractory to a further increase in pump flow, mean arterial pressure and hematocrit. The fetal heart rate returned to its baseline only after rewarming the patient to 35.5 degrees Celsius. The post-operative course was uneventful and a close follow up revealed a normal fetal status. At 38 weeks the mother delivered a healthy normal baby girl. Since fetal bradycardia occurred despite respecting all the recommendations and only reversed after rewarming the mother to 35.5 degrees Celsius, we would suggest not lowering the temperature during cardiopulmonary bypass below 35.5 degrees in pregnant patients undergoing cardiac procedures. Thus more reports and papers are mandatory in order to further elucidate the factors responsible of the adverse events that occur in such cases.},
 year = {2019}
}

Copy | Download

TY  - JOUR
T1  - Continuous Cardiac Doppler of the Fetus Guiding an Aortic Valve Replacement in an Eighteen Weeks Pregnant Woman with Active Endocarditis
AU  - Nadine Kawkabani
AU  - Roula Darwish
AU  - Moussa Abi Ghanem
AU  - Simon Bejjani
AU  - Omar Boustros
AU  - Rawad Halimeh
AU  - Joe Khalifeh
AU  - Assaad Maalouf
AU  - Bassam Abou Khalil
AU  - Elie Anastasiades
Y1  - 2019/05/15
PY  - 2019
N1  - https://doi.org/10.11648/j.ijcts.20190501.15
DO  - 10.11648/j.ijcts.20190501.15
T2  - International Journal of Cardiovascular and Thoracic Surgery
JF  - International Journal of Cardiovascular and Thoracic Surgery
JO  - International Journal of Cardiovascular and Thoracic Surgery
SP  - 21
EP  - 25
PB  - Science Publishing Group
SN  - 2575-4882
UR  - https://doi.org/10.11648/j.ijcts.20190501.15
AB  - Two percent of pregnant women experience some type of cardiac pathologic disease. In some cases surgery becomes mandatory to save the mother’s life. The maternal mortality rate in pregnant women undergoing open heart procedures is around 2.9% while the fetal mortality rate ranges between 9.5 to 29%. Many papers have advanced measures in order to decrease fetal morbidity and mortality such as tepid to normothermic cardiopulmonary bypass, good oxygenation, high hematocrit, pulsatile flow, alpha stat management, mean arterial pressure around 70mmhg and a pump flow above 2.4l/min. They recommend also a close monitoring of the fetal heart rate, uteroplacental blood flow and uterine contractions We report in this paper, the case of a 26 year old pregnant female who underwent at 18 weeks an aortic valve replacement. Severe fetal bradycardia occurred 30 min after going on bypass lasted for 20 min and was refractory to a further increase in pump flow, mean arterial pressure and hematocrit. The fetal heart rate returned to its baseline only after rewarming the patient to 35.5 degrees Celsius. The post-operative course was uneventful and a close follow up revealed a normal fetal status. At 38 weeks the mother delivered a healthy normal baby girl. Since fetal bradycardia occurred despite respecting all the recommendations and only reversed after rewarming the mother to 35.5 degrees Celsius, we would suggest not lowering the temperature during cardiopulmonary bypass below 35.5 degrees in pregnant patients undergoing cardiac procedures. Thus more reports and papers are mandatory in order to further elucidate the factors responsible of the adverse events that occur in such cases.
VL  - 5
IS  - 1
ER  -

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