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

Year 2024, Volume: 6 Issue: 1, 36 - 43, 25.03.2024

Alpin Tamay Finci Nevin Aydın

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

Abstract

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.

Keywords

Cardiac valvular disease surgery pregnancy cesarean section anesthesia

References

  • Maitra G, Sengupta S, Rudra A, Debnath S. Pregnancy and non-valvular heart disease--anesthetic considerations. Ann Card Anaesth. 2010;13(2):102-9. https://doi.org/10.4103/0971-9784.62933
  • McFaul PB, Dornan JC, Lamki H, Boyle D. Pregnancy complicated by maternal heart disease. A review of 519 women. Br J Obstet Gynaecol. 1988;95(9):861-7. https://doi.org/10.1111/j.1471-0528.1988.tb06570.x
  • Tan J, de Swiet M. Prevalence of heart disease diagnosed de novo in pregnancy in a West London population. Br J Obstet Gynaecol. 1998;105(11):1185-8. https://doi.org/10.1111/j.1471-0528.1998.tb09972.x
  • Sullivan JM, Ramanathan KB. Management of medical problems in pregnancy-severe cardiac disease. N Engl J Med. 1985;313(5):304-9. https://doi.org/10.1056/NEJM198508013130506
  • Gianopoulos JG. Cardiac disease in pregnancy. Med Clin North Am. 1989;73(3):639-51. https://doi.org/10.1016/s0025-7125(16)30662-9
  • Weiss BM, Hess OM. Pulmonary vascular disease and pregnancy: current controversies, management strategies, and perspectives. Eur Heart J. 2000;21(2):104-15. https://doi.org/10.1053/euhj.1999.1701
  • Siu SC, Sermer M, Colman JM, et al. Prospective multicenter study of pregnancy outcomes in women with heart disease. Circulation. 2001;104(5):515-21. https://doi.org/10.1161/hc3001.093437
  • Stout KK, Otto CM. Pregnancy in women with valvular heart disease. Heart. 2007;93(5):552-8. https://doi.org/10.1136/hrt.2005.067975
  • Anthony J, Osman A, Sani MU. Valvular heart disease in pregnancy. Cardiovasc J Afr. 2016;27(2):111-8. https://doi.org/10.5830/CVJA-2016-052
  • Hameed A, Karaalp IS, Tummala PP, et al. The effect of valvular heart disease on maternal and fetal outcome of pregnancy. J Am Coll Cardiol. 2001;37(3):893-9. https://doi.org/10.1016/s0735-1097(00)01198-0
  • Elkayam U, Bitar F. Valvular heart disease and pregnancy part I: native valves. J Am Coll Cardiol. 2005;46(2):223-30. https://doi.org/10.1016/j.jacc.2005.02.085
  • Ostheimer GW, Alper MH. Intrapartum anesthetic management of the pregnant patient with heart disease. Clin Obstet Gynecol. 1975;18(3):81-97. https://doi.org/10.1097/00003081-197509000-00011
  • Roberts SL, Chestnut DH. Anesthesia for the obstetric patient with cardiac disease. Clin Obstet Gynecol. 1987;30(3):601-10. https://doi.org/10.1097/00003081-198709000-00014
  • Safi LM, Tsiaras SV. Update on Valvular Heart Disease in Pregnancy. Curr Treat Options Cardiovasc Med. 2017;19(9):70. https://doi.org/10.1007/s11936-017-0570-2
  • Windram JD, Colman JM, Wald RM, Udell JA, Siu SC, Silversides CK. Valvular heart disease in pregnancy. Best Pract Res Clin Obstet Gynaecol. 2014;28(4):507-18. https://doi.org/10.1016/j.bpobgyn.2014.03.009

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

Year 2024, Volume: 6 Issue: 1, 36 - 43, 25.03.2024

Alpin Tamay Finci Nevin Aydın

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

Abstract

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.

Keywords

Kalp kapak hastalığı ameliyat gebelik sezaryen anestezi

References

  • Maitra G, Sengupta S, Rudra A, Debnath S. Pregnancy and non-valvular heart disease--anesthetic considerations. Ann Card Anaesth. 2010;13(2):102-9. https://doi.org/10.4103/0971-9784.62933
  • McFaul PB, Dornan JC, Lamki H, Boyle D. Pregnancy complicated by maternal heart disease. A review of 519 women. Br J Obstet Gynaecol. 1988;95(9):861-7. https://doi.org/10.1111/j.1471-0528.1988.tb06570.x
  • Tan J, de Swiet M. Prevalence of heart disease diagnosed de novo in pregnancy in a West London population. Br J Obstet Gynaecol. 1998;105(11):1185-8. https://doi.org/10.1111/j.1471-0528.1998.tb09972.x
  • Sullivan JM, Ramanathan KB. Management of medical problems in pregnancy-severe cardiac disease. N Engl J Med. 1985;313(5):304-9. https://doi.org/10.1056/NEJM198508013130506
  • Gianopoulos JG. Cardiac disease in pregnancy. Med Clin North Am. 1989;73(3):639-51. https://doi.org/10.1016/s0025-7125(16)30662-9
  • Weiss BM, Hess OM. Pulmonary vascular disease and pregnancy: current controversies, management strategies, and perspectives. Eur Heart J. 2000;21(2):104-15. https://doi.org/10.1053/euhj.1999.1701
  • Siu SC, Sermer M, Colman JM, et al. Prospective multicenter study of pregnancy outcomes in women with heart disease. Circulation. 2001;104(5):515-21. https://doi.org/10.1161/hc3001.093437
  • Stout KK, Otto CM. Pregnancy in women with valvular heart disease. Heart. 2007;93(5):552-8. https://doi.org/10.1136/hrt.2005.067975
  • Anthony J, Osman A, Sani MU. Valvular heart disease in pregnancy. Cardiovasc J Afr. 2016;27(2):111-8. https://doi.org/10.5830/CVJA-2016-052
  • Hameed A, Karaalp IS, Tummala PP, et al. The effect of valvular heart disease on maternal and fetal outcome of pregnancy. J Am Coll Cardiol. 2001;37(3):893-9. https://doi.org/10.1016/s0735-1097(00)01198-0
  • Elkayam U, Bitar F. Valvular heart disease and pregnancy part I: native valves. J Am Coll Cardiol. 2005;46(2):223-30. https://doi.org/10.1016/j.jacc.2005.02.085
  • Ostheimer GW, Alper MH. Intrapartum anesthetic management of the pregnant patient with heart disease. Clin Obstet Gynecol. 1975;18(3):81-97. https://doi.org/10.1097/00003081-197509000-00011
  • Roberts SL, Chestnut DH. Anesthesia for the obstetric patient with cardiac disease. Clin Obstet Gynecol. 1987;30(3):601-10. https://doi.org/10.1097/00003081-198709000-00014
  • Safi LM, Tsiaras SV. Update on Valvular Heart Disease in Pregnancy. Curr Treat Options Cardiovasc Med. 2017;19(9):70. https://doi.org/10.1007/s11936-017-0570-2
  • Windram JD, Colman JM, Wald RM, Udell JA, Siu SC, Silversides CK. Valvular heart disease in pregnancy. Best Pract Res Clin Obstet Gynaecol. 2014;28(4):507-18. https://doi.org/10.1016/j.bpobgyn.2014.03.009
There are 15 citations in total.

Details

Primary Language English
Subjects Obstetrics and Gynaecology
Journal Section Case Report
Authors

Alpin Tamay Finci This is me 0009-0004-1649-6335

Nevin Aydın 0000-0003-0189-5865

Publication Date March 25, 2024
Submission Date October 19, 2023
Acceptance Date February 16, 2024
Published in Issue Year 2024 Volume: 6 Issue: 1

Cite

APA Finci, A. T., & Aydın, N. (2024). Lessons Learned From Three Patients Who Underwent Cesarean Section and Cardiac Valvular Surgery Simultaneously: Anesthesiologists’ Perspective. Türk Kadın Sağlığı Ve Neonatoloji Dergisi, 6(1), 36-43. https://doi.org/10.46969/EZH.1377297
AMA Finci AT, Aydın N. Lessons Learned From Three Patients Who Underwent Cesarean Section and Cardiac Valvular Surgery Simultaneously: Anesthesiologists’ Perspective. Türk Kadın Sağlığı ve Neonatoloji Dergisi. March 2024;6(1):36-43. doi:10.46969/EZH.1377297
Chicago Finci, Alpin Tamay, and Nevin Aydın. “Lessons Learned From Three Patients Who Underwent Cesarean Section and Cardiac Valvular Surgery Simultaneously: Anesthesiologists’ Perspective”. Türk Kadın Sağlığı Ve Neonatoloji Dergisi 6, no. 1 (March 2024): 36-43. https://doi.org/10.46969/EZH.1377297.
EndNote Finci AT, Aydın N (March 1, 2024) Lessons Learned From Three Patients Who Underwent Cesarean Section and Cardiac Valvular Surgery Simultaneously: Anesthesiologists’ Perspective. Türk Kadın Sağlığı ve Neonatoloji Dergisi 6 1 36–43.
IEEE A. T. Finci and N. Aydın, “Lessons Learned From Three Patients Who Underwent Cesarean Section and Cardiac Valvular Surgery Simultaneously: Anesthesiologists’ Perspective”, Türk Kadın Sağlığı ve Neonatoloji Dergisi, vol. 6, no. 1, pp. 36–43, 2024, doi: 10.46969/EZH.1377297.
ISNAD Finci, Alpin Tamay - Aydın, Nevin. “Lessons Learned From Three Patients Who Underwent Cesarean Section and Cardiac Valvular Surgery Simultaneously: Anesthesiologists’ Perspective”. Türk Kadın Sağlığı ve Neonatoloji Dergisi 6/1 (March 2024), 36-43. https://doi.org/10.46969/EZH.1377297.
JAMA Finci AT, Aydın N. Lessons Learned From Three Patients Who Underwent Cesarean Section and Cardiac Valvular Surgery Simultaneously: Anesthesiologists’ Perspective. Türk Kadın Sağlığı ve Neonatoloji Dergisi. 2024;6:36–43.
MLA Finci, Alpin Tamay and Nevin Aydın. “Lessons Learned From Three Patients Who Underwent Cesarean Section and Cardiac Valvular Surgery Simultaneously: Anesthesiologists’ Perspective”. Türk Kadın Sağlığı Ve Neonatoloji Dergisi, vol. 6, no. 1, 2024, pp. 36-43, doi:10.46969/EZH.1377297.
Vancouver Finci AT, Aydın N. Lessons Learned From Three Patients Who Underwent Cesarean Section and Cardiac Valvular Surgery Simultaneously: Anesthesiologists’ Perspective. Türk Kadın Sağlığı ve Neonatoloji Dergisi. 2024;6(1):36-43.
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