Cardiac Surgery during Pregnancy-Our Experience

Abstract

Background: Rheumatic heart disease (RHD) continues to be endemic in developing countries like India, thus a number of female patient present with valvular heart disease complicating pregnancy. Surgery is lifesaving in patients who are symptomatic on medical management. Objective: To study maternal and fetal outcome in patient’s refractory to medical treatment undergoing cardiac surgery during pregnancy. Methodology: Analysis of 8 pregnant patients who underwent cardiac surgery during 5 years from Jan 2012 to Dec 2016 in a Medical college setup in Central India. Results: Maternal age ranged between 20 - 35 mean of 23.75, NYHA class IV, refractory to medical treatment. The underlying cardiac lesion was rheumatic heart disease 7 (87.5%) cases, 6 (85.7%) had mitral valve lesion. 7 primigravida (87.5%) patients were taken as elective procedure in second trimester (18 - 26 weeks), one multipara patient as emergency after failed Balloon mitral valvuloplasty (BMV) in third trimester of pregnancy (32 weeks) was the only maternal death. 5 (62.5%) patients progressed to term pregnancy and delivered vaginally. The cardiopulmonary bypass variables studied were Median bypass time 51.25 minutes (range 37 - 78), median cross-clamp time 25.62 minutes (range 16 - 48), Median flow rate 2.4 l/min/m2 (range 2.2 - 2.6) mean perfusion pressure during CPB 65 - 89 (range 55 - 120) and median perfusate temperature 37˚C (range 32 - 38). 2 (29%) patients had a long term follow-up and have delivered at term in their next pregnancies at the institute. Conclusion: Cardiac Surgery can be performed during pregnancy in patients’ refractory to medical management. The outcome is better with mother than fetus. Multidisciplinary team approach is the strategy for care.