A Case of Multidisciplinary Approach to Post-Radiotherapy Dilative Cardiomyopathy Undergoing Elective Cesarean Delivery: Anesthetic and Intensive Care Management.
A Case of Multidisciplinary Approach to Post-Radiotherapy Dilative Cardiomyopathy Undergoing Elective Cesarean Delivery: Anesthetic and Intensive Care Management.
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DOI：
10.26502/fccm.92920288
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发表时间：
2022
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心血管疾病是孕产妇死亡最常见的非产科原因。由于心血管治疗的改进，这些病例变得更加普遍。需要一个多学科的团队来管理这些妊娠。一名32岁妊娠第25周的妇女，因先前存在的放化疗引起的左心功能不全而急性心力衰竭，因呼吸困难症状加重和无尿，利尿剂治疗无效而住进了agagostino Gemelli大学IRCCS冠状动脉病房。超声心动图：射血分数30%，左心房增大，肺动脉收缩压38mmhg，双侧胸腔积液，双侧肺B线弥漫性。一个由心脏科医生、妇科医生、麻醉科医生、心脏外科医生、新生儿科医生和生物伦理学家组成的多学科团队决定在妊娠第27周在心胸混合手术室进行选择性剖宫产。麻醉采用有创连续血流动力学监测下的脊髓-硬膜外联合技术，采用Edwards Lifesciences带低血压预测指数（HPI）的血液球和ForeSight技术（Edwards Lifesciences, Irvine， USA），通过左桡动脉导管插管。保留股动脉供体外循环使用。经中心线收集脊髓针液，以0.1 mcg/kg/分钟滴注去甲肾上腺素，持续至手术结束。液体管理包括总共200毫升的晶体。HPI值未达到警戒值（最大值=10）。患者于分娩后第5天出院，血流动力学补偿良好。婴儿出生时插管，然后逐渐脱离机械通气，然后出院。
Cardiovascular diseases are the most common non-obstetric cause of maternal death. These cases became more common thanks to the improvement in cardiovascular therapies. A multidisciplinary team is necessary to manage these pregnancies. A 32 years old women at the 25th week of gestation for acute heart failure in pre-existing left ventricular dysfunction induced by radio-chemotherapy admitted to the Coronary Unit of IRCCS Policlinico Universitario Agostino Gemelli for worsening of dyspneic symptoms and anuria not responding to diuretic therapy. At the echocardiogram: ejection fraction 30%, enlarged left atrium, systolic pulmonary arterial pressure 38 mmHg, bilateral pleural effusion, bilateral diffused pulmonary B lines. A multidisciplinary team composed by cardiologists, gynecologists, anesthesiologists, cardiac surgeons, neonatologists and bioethicists decided for an elective cesarean delivery at the 27th week of gestation in the hybrid cardio-thoracic operating theater. Anesthesia was provided by combined spinal-epidural technique under invasive continuous hemodynamic monitoring with the Edwards Lifesciences HemoSphere with Hypotension Prediction Index (HPI) and ForeSight technology (Edwards Lifesciences, Irvine, USA) through catheterization of the left radial artery. The femoral arteries were left available for extracorporeal circulation. Continuous norepinephrine infusion was started once liquor was collected in the spinal needle at a 0.1 mcg/kg/minute through a central line and was continued until the end of surgery. Fluid management consisted of a total of 200 ml of crystalloids. HPI values never reached alarm values (maximum value =10). The patient was discharged home on the 5th day after delivery with good hemodynamic compensation. The baby was intubated at birth and then gradually weaned from mechanical ventilation, then discharged.