Tactics of anaesthesiological support and intensive therapy of the pregnant having hemodynamically significant inherent cardiac disorders. Analysis of a series of clinical observations

A.E. Bautin, N.V. Aram-Balyk, V.A. Mazurok, A.V. Yakubov, A.S. Bobkova, N.V. Badalyan, Yu.A. Kokonina, O.A. Li, O.B. Irtyuga, I.E. Zazerskaya, O.M. Moiseyeva
Keywords: congenital heart diseases, pulmonary arterial hypertension, pregnancy, Eisenmenger syndrome, cesarean section, anesthesia, intensive care.
Medicinskij al'manah, 2017, issue 3, pages 137-143.

The aim of the study was to analyze data on anesthesia and intensive care in the peripartic period in
patients with hemodynamically significant CHD. A retrospective analysis of 18 cases of delivery in patients
undergoing treatment at the Specialized Perinatal Center at the SZFMITS named after V.A. Almazov in
2010–2017 years. The criteria for inclusion in the study were the presence of CHD and pulmonary artery
systolic pressure more than 60 mm Hg. Among the heart defects are: the defect of the interventricular
septum – in 11 patients; сomplete atrio-ventricular canal – in two cases; open arterial duct – in two cases;
atrial septal defect - in two patients; one case of aorto-pulmonary anastomosis. In 12 of 18 cases (66,7%),
patients developed Eisenmenger syndrome. In the antenatal period, 16 patients received sildenafil therapy.
The median gestational age at the time of delivery was 32 (28; 34) weeks. In 17 cases (94,4%), the birth
was performed through a cesarean section, one patient gave birth alone. The priority method of anesthesia
was combined anesthesia based on epidural blockade (16 cases). In all patients after 29 (23, 40) h after
delivery, decompensation of the state with the increase of pulmonary hypertension, progression of right
ventricular failure, an increase in shunting from right to left developed. In 4 cases, a transfer to mechanical
ventilation was required, intensive therapy included a combined use of vasodilators, the use of inotropes,
the prevention of thromboembolic complications. The median duration of treatment in the ICU was 12,5
(9; 24) days. Three patients died (16,7%), Mortality in the subgroup of Eisenmenger syndrome was 25%
(3/12). 15 (83,3%) children were discharged from the hospital in a satisfactory condition.

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A.E. Bautin, N.V. Aram-Balyk, V.A. Mazurok, A.V. Yakubov, A.S. Bobkova, N.V. Badalyan, Yu.A. Kokonina, O.A. Li, O.B. Irtyuga, I.E. Zazerskaya, O.M. Moiseyeva Tactics of anaesthesiological support and intensive therapy of the pregnant having hemodynamically significant inherent cardiac disorders. Analysis of a series of clinical observations. Medicinskij al'manah 2017; (3): 137–143, http://dx.doi.org/10.21145/2499-9954-2017-3-137-143