■双胎妊娠重做主动脉瓣置换术带来了巨大的挑战,因为孕妇和胎儿健康的风险都很高。专业中心的死亡率从12%到21%不等,以前的心脏手术进一步增加了风险。怀孕会使心脏手术复杂化,胎儿死亡率高达16-33%。
方法:一个31岁的女人,怀孕15周,有双胞胎,有机械主动脉瓣置换术史,表现为呼吸困难恶化和III级呼吸困难。超声心动图显示严重的瓣膜阻塞,需要重做主动脉瓣置换术和后主动脉根部扩大。尽管术中存在挑战,包括心室纤颤和术后心脏传导阻滞,她接受了成功的手术和起搏器植入,母亲和胎儿都保持稳定。
结论:手术的最佳时机至关重要,考虑到妊娠早期的胎儿发育脆弱性和妊娠晚期的母体心脏负荷。妊娠中期风险与非妊娠患者相当。在旁路期间对胎儿-胎盘灌注的有限理解需要谨慎的管理策略,随着脉冲灌注等新兴技术显示出希望。麻醉选择优先考虑胎儿安全,而在手术过程中监测胎儿窘迫仍然具有挑战性。为了在接受重做主动脉瓣置换术的双胎妊娠中实现母亲和婴儿的成功结局,小心时机,适当的手术技术,细致的围手术期护理至关重要。
结论:多学科方法对于重做主动脉瓣手术后处理双胎妊娠至关重要。精心策划,密切监测,专业的手术和麻醉技术是将母亲和胎儿的风险降至最低的关键。
UNASSIGNED: Redo aortic valve replacement in twin pregnancy presents significant challenges because of the elevated risks for both maternal and fetal health. Mortality rates range from 12 % to 21 % in specialised centres, with previous cardiac surgeries further elevating the risk. Pregnancy complicates cardiac surgery, with fetal mortality rates as high as 16-33 %.
METHODS: A 31-year-old woman, 15 weeks pregnant with twins and with a history of mechanical aortic valve replacement, presented with worsening breathlessness and grade III dyspnoea. Echocardiography revealed severe valve obstruction, necessitating redo-aortic valve replacement and posterior aortic root enlargement. Despite intraoperative challenges, including ventricular fibrillation and postoperative heart block, she underwent successful surgery and pacemaker implantation, with both mother and fetuses remaining stable.
CONCLUSIONS: Optimal timing of surgery is crucial, considering fetal developmental vulnerability in the first trimester and maternal cardiac workload in the third trimester. Second-trimester risks are comparable to non-pregnant patients. A limited understanding of fetal-placental perfusion during bypass necessitates cautious management strategies, with emerging techniques like pulsatile perfusion showing promise. Anaesthesia selection prioritises fetal safety while monitoring fetal distress during surgery remains challenging. To achieve successful outcomes for both mother and babies in a twin pregnancy undergoing a redo aortic valve replacement, careful timing, appropriate surgical techniques, and meticulous perioperative care are essential.
CONCLUSIONS: A multidisciplinary approach is crucial for managing twin pregnancy following redo aortic valve surgery. Careful planning, close monitoring, and specialised surgical and anaesthetic techniques are key to minimising risks to both mother and fetus.