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Novel use of intracardiac echography for fetal monitoring during maternal cardiac surgery
Abstract Number: SU-89
Abstract Type: Case Report/Case Series
A 43-year-old nulliparous woman presented scheduled Sinus of Valsalva aneurysm (SVA) surgery at 18 weeks of gestational age after treatment of infertility. Patient has been had SVA before pregnancy and the size of the aneurysm extended to 49 mm diameter at 17 weeks. A heart surgery became mandatory and Surgical repair of SVA under cardiopulmonary bypass (CPB) was scheduled. An intracardiacechography (ICE) was inserted via the left femoral vein before start surgery. The fetus umbilical artery Doppler wave was monitored entire surgery (Figure 1). Aesthesia and Hemodynamic was managed base on the Doppler wave information. The mother and fetus kept in good condition during and after the surgery.
The early gestational period and use of CPB during pregnancy were associated with high feto-neonatal mortality. The fetal mortality rate during cardiac surgery with CPB still remains high, the maternal mortality rate range from 1.5% to 5% and the fetal mortality rate range from 9.5% to 29%. Fetal bradycardia is known to develop frequently during the initiation of CPB. Monitoring of fetal heart rate and the uterus has been reported to reduce fetal mortality rate to 9.5% by enabling early recognition of potential problems during CPB and timely provision of the required treatment.
Thus, fetal monitoring is important especially during CPB. We used ICE via femoral vein to monitor Doppler signals of fetal umbilical artery in a patient who underwent repair of sinus of SVA. There was no interference during the entire surgery.
ICE is a technique for imaging of intracardiac structures, and may serve as an alternative for the transesophageal approach.The mechanical ultrasound transducer tipped catheter can be used for both intravascular and intracardiac imaging. For intracardiac use,a 9 MHz single element transducer is incorporated in an 8 French catheter.
We used ICE via the femoral vein to monitor Doppler signals of the fetal umbilical artery in a patient who underwent repair of her SVA. During the CPB, ICE detected fetal bradycardia, which was corrected after keeping maternal blood pressure higher. This is the first reported case of ICE being used for fetal monitoring.