Challenges and strategies regarding anaesthetic management of twin pregnancy undergoing redo aortic valve replacement.

Autor:	Yousuf MS; Department of Anaesthesiology, The Aga Khan University Hospital, P.O Box 3500, Stadium Road, Karachi 74800, Pakistan. Electronic address: saad.yousuf@aku.edu., Ali MQ; Department of Anaesthesiology, The Aga Khan University Hospital, P.O Box 3500, Stadium Road, Karachi 74800, Pakistan., Ahmed SS; Department of Anaesthesiology, The Aga Khan University Hospital, P.O Box 3500, Stadium Road, Karachi 74800, Pakistan., Naqvi HI; Department of Anaesthesiology, The Aga Khan University Hospital, P.O Box 3500, Stadium Road, Karachi 74800, Pakistan., Siddiqui K; Department of Anaesthesiology, The Aga Khan University Hospital, P.O Box 3500, Stadium Road, Karachi 74800, Pakistan., Samad K; Department of Anaesthesiology, The Aga Khan University Hospital, P.O Box 3500, Stadium Road, Karachi 74800, Pakistan.
Jazyk:	angličtina
Zdroj:	International journal of surgery case reports [Int J Surg Case Rep] 2024 Sep; Vol. 122, pp. 110176. Date of Electronic Publication: 2024 Aug 14.
DOI:	10.1016/j.ijscr.2024.110176
Abstrakt:	Introduction and Importance: 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 %. Presentation of Case: 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. Discussion: 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. Conclusion: 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. Competing Interests: Conflict of interest statement Nothing to declare. (Copyright © 2024 The Authors. Published by Elsevier Ltd.. All rights reserved.)
Databáze:	MEDLINE
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