Document Detail


Mitral valve replacement in pregnancy: a successful strategy for fetal survival.
MedLine Citation:
PMID:  21214106     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
The incidence of bacterial endocarditis (BE) during pregnancy is about 0.01%, while maternal and fetal mortality rates due to BE are 22% and 15%, respectively. Fetal survival is <15% until week 25 of gestation, and cesarean delivery is recommended before cardiopulmonary bypass in the third trimester. The case is described of a 24-year-old woman (a known drug addict), gravida 1, para 0, at week 22 of gestation, with an acute mitral valve endocarditis caused by Staphylococcus aureus. Following urgent mitral valve replacement, the strategy for fetal survival involved reducing the hemodilution and scavenging the cardioplegia solution from the right atrium, avoiding deep hypothermia to minimize rewarming, and maintaining a high pump flow rate (>2.5 l/min/m2) with a mean perfusion pressure of 70 mmHg, using pulsatile perfusion. The patient had an uneventful postoperative course, and at 34 weeks' gestation a normal newborn of 1780 g was delivered by cesarean section. No controlled clinical trials using extracorporeal circulation during pregnancy have been conducted, and reports are limited to single cases. A strategy was proposed to manage the present case of uncontrolled maternal BE at an early gestational age, by addressing several factors that would influence the outcome for both mother and baby.
Authors:
Mirko Muretti; Tiziano M Torre; Romano Mauri; Rafael Trunfio; Giorgio Moschovitis; Francesco Siclari
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Publication Detail:
Type:  Case Reports; Journal Article    
Journal Detail:
Title:  The Journal of heart valve disease     Volume:  19     ISSN:  0966-8519     ISO Abbreviation:  J. Heart Valve Dis.     Publication Date:  2010 Nov 
Date Detail:
Created Date:  2011-01-10     Completed Date:  2011-01-21     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  9312096     Medline TA:  J Heart Valve Dis     Country:  England    
Other Details:
Languages:  eng     Pagination:  789-91     Citation Subset:  IM    
Affiliation:
Department of Cardiac Surgery, Cardiocentro Ticino, Lugano. mirko.muretti@cardiocentro.org
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MeSH Terms
Descriptor/Qualifier:
Anti-Bacterial Agents / therapeutic use
Cesarean Section
Endocarditis, Bacterial / microbiology,  surgery*
Female
Gestational Age
Heart Arrest, Induced
Heart Valve Prosthesis Implantation*
Humans
Live Birth
Mitral Valve / microbiology,  surgery*
Pregnancy
Pregnancy Complications, Cardiovascular / microbiology,  surgery*
Pregnancy Complications, Infectious / microbiology,  surgery*
Staphylococcus aureus / isolation & purification
Substance Abuse, Intravenous / complications*
Treatment Outcome
Young Adult
Chemical
Reg. No./Substance:
0/Anti-Bacterial Agents

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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