Abstract：
METHODS: Herein we present the case of a 33-year nulliparous woman at 21 weeks of gestation with mitral valve vegetation resulting from infective endocarditis. Due to the mother\'s critical condition caused by consecutive thromboembolic events, surgery with cardiopulmonary bypass was indicated. During surgery the fetus was monitored by a specialized obstetrician who repetitively measured the Doppler indices of the umbilical artery, Ductus venosus and uterine artery. Right after CO2 was insufflated into the operating area, the Doppler monitoring showed an increased Pulsatility Index of the Umbilical artery right before fetal distress with bradycardia occurred. A subsequent maternal arterial blood gas analysis showed an acidosis with hypercapnia. Consequently, the CO2 insufflation was stopped and the gas flow on the Heart Lung Machine increased. After regaining homeostasis of acidosis, the Doppler Indices and fetal heart rate recovered. The remaining surgery and postoperative course were uneventful. At the 37 weeks of gestation a healthy boy was delivered by Cesarean section and at the age of two years, the neurodevelopment was assessed, which indicated normal development in mental cognition, language and motoric. This report presents a periodic Doppler examination of the maternal and fetal circulation during surgery on CPB while also discussing the possible impact of fetal monitoring in managing open cardiac surgery in pregnancy.
摘要：
方法：在此，我们介绍了一名33岁的未产妇女在妊娠21周时因感染性心内膜炎导致二尖瓣植被的情况。由于连续的血栓栓塞事件导致母亲的病情危重,需要进行体外循环手术.在手术过程中，由专门的产科医生监测胎儿，该产科医生反复测量脐动脉的多普勒指数，静脉导管和子宫动脉。就在二氧化碳吹入手术区域后，多普勒监测显示,在胎儿宫内窘迫伴心动过缓发生前,脐动脉搏动指数升高.随后的母体动脉血气分析显示酸中毒伴高碳酸血症。因此,停止CO2吹气，心肺机上的气体流量增加。在恢复酸中毒的体内平衡后，多普勒指数和胎儿心率恢复。其余手术和术后病程均顺利。在妊娠37周时，一个健康的男孩被剖腹产，两岁时，评估了神经发育，这表明了心理认知的正常发展，语言和机动。本报告介绍了CPB手术过程中对母体和胎儿循环的定期多普勒检查，同时还讨论了胎儿监测在妊娠开放心脏手术中的可能影响。
