Cardiosurgical endovascular intervention during pregnancy

Keywords: endovascular interventions; cardiosurgery; pregnancy.

Abstract

Objective. To share the experience of endovascular interventions in pregnant women and women in labor, gained by national team “obstetric cardiology”.

Materials and methods. The algorithm of medical support was presented, including the cases of cardiosurgical interventions performance , for pregnant women with critically severe pathology of the heart, which was based on actual recommendations and own experience. Into the clinic of Amosov National Institute of Cardiovascular Surgery during 6.5 yrs (12.2013 - 05.2020) 145 women-patients were admitted to hospital, in 79 of them cardiosurgical intervention was done. Endovascular cardiosurgical operations were performed in 36 patients, and the hybrid - in 2. Urgent and emergency endovascular interventions were performed in 17 women-patients with various terms of pregnancy (15 - 35 weeks) and in 2 women in labor. Conditionally-elective cardiosurgical interventions were performed in 17 women-patients on various terms of pregnancy (as a rule, in II trimester) and in 2 women in labor. In 34 patients the interventions were performed with fetus in utero. Early and late maternal mortality was absent. One «programmed» loss of the fetus have occurred on 12-th week of pregnancy with the inborn heart failure. Modern views on impact of ionized radiation and contrast substances on fetus were presented, and the methods of lowering of their potential harm.

Conclusion. There was trusted, that while applying strict indications for performance of endovascular interventions during pregnancy, these methods of diagnosis and treatment are more secure in comparison with «open» operative interventions and may be performed under supervision of experienced multidisciplinary team, taking into account the pregnancy term and the fetus defense.

Author Biographies

S. O. Siromakha, Amosov National Institute of Cardiovascular Surgery, Kyiv

Siromakha Serhii O., MD, PhD(Med), Associate Professor
Chief medical officer M.M. Amosov National Institute of Cardiovascular Surgery, Associate Professor Department of Surgery No 2,
O.O.Bogomolets National Medical University
03038, Ukraine, Kyiv, 6, N. Amosov str.
+380 44 275-40-22
newsersir@gmail.com;
https://orcid.org/0000-0002-7031-5732

Yu. V. Davydova, Lukyanova Institute of Pediatry, Obstetrics and Gynecology, Kyiv

Davydova Yulia.V., MD, DSci(Med), Professor, chief researcher
Department of Surgical Treatment of Congenital Heart Diseases in Newborns and Young Children
M.M. Amosov National Institute of Cardiovascular Surgery,
Head of the department of obstetric problems of extragenital pathology,
Lukianova Institute of Pediatrics, Obstetrics and Gynecology
03038, Ukraine, Kyiv, 6, N. Amosov str.
+380 44 275-40-22
plaksenko.yulia@gmail.com
orcid.org/0000-0001-9747-1738

A. Yu. Limanska, Bogomolets National Medical University, Kyiv

Limanska AlisaYu, MD, PhD(Med), Associate Professor, Leading Researcher
of the department of obstetric problems of extragenital pathology,
Lukianova Institute of Pediatrics, Obstetrics and Gynecology,
Associate Professor, Department of Internal Medicine No 2
O.O.Bogomolets National Medical University
04050, Kyiv, str. Platona Mayborody 8,
limanskaya2608@gmail.com;

B. V. Cherpak, Amosov National Institute of Cardiovascular Surgery, Kyiv

Cherpak BohdanV., MD
Department of Surgical Treatment of Congenital Heart Diseases in Newborns and Young Children
M.M. Amosov National Institute of Cardiovascular Surgery,
+380 44 275 42 33
03038, Ukraine, Kyiv, 6, N. Amosov str.
https:// orcid.org/0000-0002-9956-0432

V. V. Lazoryshynets, Amosov National Institute of Cardiovascular Surgery, Kyiv

Lazoryshynets Vasyl.V - MD, DSci(Med), Professor
Director of Amosov National Institute of Cardiovascular Surgery
03680, Amosov Str,6
050-310-92-08
lazoryshynets@amosovinstitute.org.ua
https://orcid.org/0000-0002-1748-561X

References

Kapoor MC. Cardiopulmonary bypass in pregnancy. Ann Card Anaesth. 2014;17(1):33-9. doi:10.4103/0971-9784.124133.

Patel A, Asopa S, Tang AT, Ohri SK. Cardiac surgery during pregnancy. Tex Heart Inst J. 2008;35(3):307-12. PMCID: PMC2565548.

Akira ISHII, Susumu MIYAMOTO. Endovascular Treatment in Pregnancy. Neurol Med Chir 2013;53(8):541-8 doi: 10.2176/nmc.53.541.

Shaw P, Duncan A, Vouyouka A, Ozsvath K. Radiation exposure and pregnancy. J Vasc Surg. 2011;53(1):28S-34S. doi: 10.1016/j.jvs.2010.05.140.

Regitz-Zagrosek V, Roos-Hesselink JW, Bauersachs J, Blomström-Lundqvist C, Cífková R, De Bonis M, et al. 2018 ESC Guidelines for the management of cardiovascular diseases during pregnancy. Eur Heart J. 2018 Sep 7;39(34):3165-241. doi: 10.1093/eurheartj/ehy340.

European Society of Gynecology (ESG); Association for European Paediatric Cardiology (AEPC); German Society for Gender Medicine (DGesGM), Regitz-Zagrosek V, Blomstrom Lundqvist C, Borghi C, et al. ESC Guidelines on the management of cardiovascular diseases during pregnancy: the Task Force on the Management of Cardiovascular Diseases during Pregnancy of the European Society of Cardiology (ESC). Eur Heart J. 2011 Dec;32(24):3147-97. doi: 10.1093/eurheartj/ehr218.

American Society of Radiologic Technologists xray risk calculator [Internet]. Jan 28 2018. Available from: https://www.xrayrisk.com/index.php.

Sadro CT, Dubinsky TJ. CT in pregnancy: Risks and benefits. Appl Radiol. [Internet]; October 2013: 6-16. Available from: https://docs.google.com/viewer?url=https%3A%2F%2Fcdn.agilitycms.com%2Fapplied-radiology%2FPDFs%2FAR_10-13_Sadro.pdf.

Hirshfeld JW Jr, Ferrari VA, Bengel FM, Bergersen L, Chambers CE, Einstein AJ, et al. 2018 ACC/HRS/NASCI/SCAI/SCCT Expert Consensus Document on Optimal Use of Ionizing Radiation in Cardiovascular Imaging-Best Practices for Safety and Effectiveness, Part 2: Radiological Equipment Operation, Dose-Sparing Methodologies, Patient and Medical Personnel Protection: A Report of the American College of Cardiology Task Force on Expert Consensus Decision Pathways. J Am Coll Cardiol. 2018 Jun 19;71(24):2829-55. doi: 10.1016/j.jacc.2018.02.018.

Committee on Obstetric Practice. Committee Opinion No. 723: Guidelines for Diagnostic Imaging During Pregnancy and Lactation. Obstet Gynecol. 2017 Oct;130(4):e210-e216. doi: 10.1097/AOG.0000000000002355. Erratum in: Obstet Gynecol. 2018 Sep;132(3):786. .

Published
2020-06-26
How to Cite
Siromakha, S. O., Davydova, Y. V., Limanska, A. Y., Cherpak, B. V., & Lazoryshynets, V. V. (2020). Cardiosurgical endovascular intervention during pregnancy. Klinicheskaia Khirurgiia, 87(3-4), 49-54. https://doi.org/10.26779/2522-1396.2020.3-4.49
Section
General Problems of Surgery