Urgent cardiac surgery during pregnancy: a continuous challenge.

Background: Cardiac surgery during pregnancy is reserved for cases of failure of medical treatment due to its detrimental maternal and fetal effects.

Methods: Between March 2003 and December 2012, 23 pregnant women with severe valve malfunction required open heart surgery. The mean age was 30.3±4.9 years. Gestational age ranged from 14 to 39 weeks. Twenty patients (87%) presented with signs of right ventricular failure. The main presenting lesion was severe aortic stenosis in 3 patients (13%), mitral stenosis in 3 patients (13%), and stuck mechanical mitral valve prosthesis in 17 patients (73.9%).

Results: Fourteen patients were operated upon on emergency basis, and 9 patients on urgent basis. Two patients have continued their pregnancy to full term after cardiac surgery. Delivery was done immediately before surgery in 11 patients (47.8%). There were 10 intrauterine fetal deaths, all at gestational age below 28 weeks, 4 were confirmed before induction of anesthesia and 6 after surgery. There were 13 surviving babies, 7 premature babies (30.4%), and 6 full term babies (26.1%). Neonatal complications included respiratory distress syndrome in (38.5%) and prolonged hospital stay (46.2%). Maternal hospital morbidities included oliguria (65.2%), bleeding (30.4%), prolonged intensive care stay (56.5%), and prolonged hospital stay (26.2%). The in-hospital mortality was 8.7%.

Conclusions: Urgent and emergency valve replacement in pregnant women can be achieved with good maternal morbidity and mortality; however, high incidence of fetal losses might be expected when surgery is performed at an early gestational age.