Feasibility study of single-stage cesarean section and cardiac surgery in pregnant women with severe heart disease in the third trimester

doi:10.3877/cma.j.issn.1673-5250.2022.01.006

Objective

To explore feasibility of single-stage cesarean section and cardiac surgery in pregnant women with severe heart disease (SHD) in the third trimester.

Methods

A total of 21 cases of pregnant women with SHD in the third trimester who received single-stage cesarean section and cardiac surgery in Beijing Anzhen Hospital, Capital Medical University from 2012 to 2020 were selected as research subjects. General clinical data, perioperative conditions and pregnancy outcomes of mothers and infants were retrospectively analyzed. The procedure followed in this study complied with requirements of the Medical Ethics Committee of Beijing Anzhen Hospital, Capital Medical University and was approved by the ethics committee (Approval No. 2022027X).

Results

①At delivery, the age of 21 cases of SHD pregnant women was (30.8±4.0) years old, body mass index (BMI) was (25.0±5.6) kg/m². Gestational age of delivery was (32.5±3.5) gestational weeks, including 6 cases (28.6%) of term delivery. 22 newborns were born, and neonatal body length was (45.1±3.9) cm, body weight was (2 342.0±727.3) g. Apgar scores of 1 min, 5 min and 10 min after birth were (7.4±2.5) points, (9.0±1.0) points and (9.6±1.0) points, respectively. Neonatal survival rate was 100.0% (22/22). ②In 21 cases of SHD pregnant women, there were 13 cases (61.9%) of aortic dissection, 7 cases (33.3%) of thoracic/abdominal aortic aneurysm, 6 case (28.6%) of pericardial effusion, and 5 cases (23.8%) of cardiac enlargement. Moderate and severe aortic regurgitation accounted for 61.9% (13/21), and 90.5% (19/21) of patients with cardiac function grade Ⅱ or above. 18 cases (85.7%) had two or more kinds of SHD. ③There were 8 kinds of cardiac operation in single-stage with cesarean section by multi-disciplinary team (MDT). The operation time of cardiac operation was (369.8±100.6) min and volume of blood loss was 1 157.4 mL (750.0-1 550.0 mL). Cardiopulmonary bypass (CPB) time was (139.0±45.1) min and all pregnant women survived.

Conclusions

For SHD pregnant women in the third trimester, it is feasible to perform single-stage cesarean section and cardiac surgery by MDT to provide protection for maternal and neonatal life safety.

Key words: Pregnancy complications, cardiovascular, Heart diseases, Pregnancy trimester, third, Cardiac surgical procedures, Pregnancy outcome, Pregnant women

表1 本组21例晚孕期SHD孕妇的SHD类型、合并症、主动脉瓣关闭不全及心功能分级情况[例数(%)]

项目		发生率	项目		发生率	项目		发生率
SHD类型			合并症			主动脉瓣关闭不全
	主动脉夹层	13(61.9)		妊娠期高血压疾病	7(33.3)		中度	7(33.3)
	胸/腹主动脉瘤	7(33.3)		妊娠期糖尿病	5(23.8)		重度	6(28.6)
	心包积液	6(28.6)		马方综合征	3(14.3)	心功能分级(级)
	心脏扩大	5(23.8)		肺不张	3(14.3)		Ⅰ	2(9.5)
	心律失常	2(9.5)		双胎妊娠	1(4.8)		Ⅱ	6(28.6)
	心房黏液瘤	2(9.5)	主动脉瓣关闭不全				Ⅲ	8(38.1)
	感染性心内膜炎	1(4.8)		无/轻度	8(38.1)		Ⅳ	5(23.8)

表1 本组21例晚孕期SHD孕妇的SHD类型、合并症、主动脉瓣关闭不全及心功能分级情况[例数(%)]

项目		发生率	项目		发生率	项目		发生率
SHD类型			合并症			主动脉瓣关闭不全
	主动脉夹层	13(61.9)		妊娠期高血压疾病	7(33.3)		中度	7(33.3)
	胸/腹主动脉瘤	7(33.3)		妊娠期糖尿病	5(23.8)		重度	6(28.6)
	心包积液	6(28.6)		马方综合征	3(14.3)	心功能分级(级)
	心脏扩大	5(23.8)		肺不张	3(14.3)		Ⅰ	2(9.5)
	心律失常	2(9.5)		双胎妊娠	1(4.8)		Ⅱ	6(28.6)
	心房黏液瘤	2(9.5)	主动脉瓣关闭不全				Ⅲ	8(38.1)
	感染性心内膜炎	1(4.8)		无/轻度	8(38.1)		Ⅳ	5(23.8)

表2 本组21例晚孕期SHD孕妇分娩孕龄及心脏病手术术式比较[例数(%)]

项目		发生率	项目		发生率
分娩孕龄(周)			心脏手术术式
	<37	15(71.4)		Bentall手术+部分主动脉弓人工血管置换术	2(9.5)
	≥37	6(28.6)		Bentall手术+冠状动脉旁路移植术	1(4.8)
心脏手术术式				左心房黏液瘤切除术	2(9.5)
	Bentall手术	6(28.6)		Valsalva手术	1(4.8)
	Bentall+SUN′S手术	4(19.0)		主动脉瓣机械瓣膜置换±二尖瓣瓣环成形+升主动脉包裹术	3(14.3)
	主动脉置换术	2(9.5)

表2 本组21例晚孕期SHD孕妇分娩孕龄及心脏病手术术式比较[例数(%)]

项目		发生率	项目		发生率
分娩孕龄(周)			心脏手术术式
	<37	15(71.4)		Bentall手术+部分主动脉弓人工血管置换术	2(9.5)
	≥37	6(28.6)		Bentall手术+冠状动脉旁路移植术	1(4.8)
心脏手术术式				左心房黏液瘤切除术	2(9.5)
	Bentall手术	6(28.6)		Valsalva手术	1(4.8)
	Bentall+SUN′S手术	4(19.0)		主动脉瓣机械瓣膜置换±二尖瓣瓣环成形+升主动脉包裹术	3(14.3)
	主动脉置换术	2(9.5)

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