Pregnant mothers have a "heart killer" with high warmth, and can continue pregnancy after the breast opening surgery

Text/Yangcheng Evening News all -media reporter Yu Yanhong

Correspondent Bai Tian Wang Hui

Figure/Interviewee provided (except for signatures)

With pregnancy for surgery, I feel that the risk is not small when I hear it.

However, a few days ago, a 38 -week pregnant mother A Lan (a pseudonym), a 28 -week pregnancy of the third hospital of Guangzhou Medical University (hereinafter referred to as "Guangyi 3 Hospital"), encountered a terrible "heart killer" during pregnancy -infected heart endometriumInflammation, it continues to high fever, and even faces heart failure and severe anemia.

The mother and baby were in danger, and had to perform breast opening surgery during pregnancy.

Bao Da is also small, and the Guangzhou Medical Third Hospital of Guangzhou Chronic Maternal Maternal Maternal Cure Center, Cardiac Surgery, Anesthesiology, Critical Medicine, Ultrasonic Medicine and other disciplines are united.The high difficulty and high -risk surgery of the removal of the removal+two -pointed valve replacement+closure of the chest cavity ".

The surgery not only successfully eliminated the infection of the heart and replaced the artificial valve; under the escort of multidisciplinary experts, the fetal abortion was avoided during the operation. Alan can continue to be pregnant until 38 weeks after surgery.

On June 17, Alan gave birth to a child in the Third Hospital of Guangyi and was discharged from the hospital.This is also the first maternal maternal maternal maternal for "continuing pregnancy after the in vitro circulation heart surgery".

Liu Shenghua, Deputy Chief Physician of the Cardios Surgery of the Third Hospital of Guangyi, explained the case diagram/Yu Yanhong

Alan, 34, did not expect that a fever was almost "terrible."On March 23, Alan, who was 7 months pregnant, felt unwell and had symptoms of high fever.

At the time of the new crown pneumonia, A Lan and his family were very nervous and went to the hospital for the first time.The nucleic acid detection in the outer hospital is negative, and the possibility of new crown pneumonia is excluded.

But in the next week, Alan still had a high fever, and her body temperature was burned to more than 39 degrees. Alan also appeared cough, chest tightness, poor breathing, and could not even lie flat.smooth.

In the early morning of March 30, A Lan was urgently transferred to the Guangzhou Medical Maternal Maternal Maternity Center in Guangzhou Medical University Third Hospital.

After careful examination, the doctor found that Alan was not an ordinary fever, but a severe infection of the valve of the heart.Multi -place perforations form a severe return, and the heart valve has noise.Subsequently, Alan was diagnosed by the doctor -infective endocarditis.

"This is a more difficult heart disease, especially for pregnant women. If you do not surgery as soon as possible, bacteria with bacteria in the heart may fall off at any time, leading to embolism in other organs. At the same time, heart failure will continue to increase the loss of surgery.Opportunity, mother and child will have fatal risks. "

When he was transferred to the third hospital of Guangyi, although Alan was soberly conscious, the whole person was embarrassed and weak.Due to severe bacterial infections, Alan’s heart two -pointed valve was severely damaged, and he needed to perform heart -changing surgery as soon as possible. Otherwise, Alan may have heart failure at any time, arrest of heartbeat, and fetal distress in the fetus.

However, Alan, who was 7 months pregnant, had a major surgery and was related to one, one, and two lives.On March 31, the Guangzhou Creative Maternal Maternal Cure Center of the hospital carried out multi -disciplinary consultation and condition discussion.Two treatment plans are in front of you:

The first plan is to stop pregnancy immediately and perform parallel cardia.

The second scheme is mainly to ensure the safety of pregnant women, first cardiac surgery, and giving the fetus to continue pregnancy, but surgery may bring abortion.

No matter what kind of scheme is a huge test for maternal and child safety, the latter plan must be large and small, which greatly increases the difficulty of surgery, and the possibility of success is very small.

After fully communicating with their families, the multidisciplinary experts of the Third Hospital of Guangyi made a "bold" decision after many discussions -surgery must be done, but children must also guarantee.Time to extend the fetus in the palace as much as possible.

"For pregnant women with heart -changing surgery, they must also take into account the safety of the fetus during the operation. They have put forward higher requirements for cardiac surgery of anesthesia and low -temperature body circulation and the monitoring of maternal and infant life during the operation."

Liu Shenghua, deputy chief physician of the Cardiosurgery Surgery of the Third Hospital of Guangyi, introduced: "In the in vitro cycle of heart surgery, in order to ensure the safety of surgery, cooling treatment will be performed when the in vitro circulation is implemented, and the body temperature will be reduced to about 32 degrees.Patients are pregnant women, and low temperatures may cause the fetal heartbeat arbitration. In addition, the trauma and drugs of anesthesia and surgery are strong stimulation for the fetus and may cause abortion. "

At 9 o’clock on April 2nd, Alan was pushed into the operating room.Due to the rapid progress of the condition, A Lan could not lie down, and the anesthesiologist could only give anesthesia in the case of half -lying, and did not flatten it until the formal starting surgery.

"Surgical doctors have chest surgery, obstetricians have fetal supervision throughout the process, in vitro recycles monitoring internal environment, and pediatricians surgery." On the day of surgeryProfessor Chen Dunjin, director of the Specialist doctors, also came to the scene in person.

On April 2nd, the treatment team of Guangzhou severely ill pregnant women in Guangzhou Third Hospital of Guangzhou Hospital performed cardiac surgery for pregnant women Alan (pseudonym)

In order to take into account the safety of motherhood, the surgical team and anesthesiologist perform in vitro circulation surgery under normal temperature (strict control at 34.0 ° ~ 35.0 °).

Director Su Zhiyuan, who is responsible for in vitro circulation, carefully controls the machine to operate at the maximum load, and strives to maintain the balance of the internal environment, so that the entire process is as close to the physiological state as much as possible to avoid stimulation of the fetus.

In vitro circulation of the heart surgery, anticoagulant drugs are used to ensure that the blood flow is not easy to solidify, but anticoagulant drugs may cause placental bleeding and cause fetal death. For this reason, the team is very careful in the use of various parameters and drug dosage.Be cautious, the surgical monitoring throughout the process is dare not to have a little relaxation.

In addition to strict surveillance, blood during surgery is also a big problem.Patients with endocarditis in infectious cardiac are often caused by severe infection, and abnormal coagulation function will increase the risk of blood loss during cardiac surgery.

However, enough blood is very important for the fetus in Alan’s belly. To continue pregnancy after cardiac surgery, it is necessary to ensure that the hemoglobin during the operation is high enough.

After learning about the situation of Alan, the hospital’s medical department and blood storage attached great importance to it. In the case of very tight blood in the epidemic, they applied to Guangzhou Blood Station in advance and had enough blood.

During the operation, when Director Liu Shenghua opened his heart, A Lan’s heart valve was severely violated by bacteria, and almost all of the valve was damaged. A large number of bacterial removing creatures were attached to the original translucent heart valve, and the valve was like corroded.

Liu Shenghua quickly cleaned up necrotic valve and bacterial hiechgenia, replaced artificial valve, and completed surgery at the fastest speed to reduce trauma to maternal and infants.

In order to ensure the safety of maternal and infants, Alan lost 800ml red blood cells, 800ml plasma, 1U platelets, and 500ml of autologous blood, which is equivalent to replacing half of the blood of the whole body.

Fortunately, the entire surgery process, the fetal condition was stable, and the postoperative monitoring occurred accidentally.That afternoon, Alan woke up. The next day, Alan felt the fetal movement.After a six -week anti -infection treatment, A Lan was discharged from the hospital.

On June 17, Alan, who had already been 38 weeks of pregnancy, returned to the third hospital of Guangyi. Under the full -scale escort of the delivery room, a healthy child was given.Alan’s postpartum is in good condition and can be discharged from the hospital.

It is reported that there are few cases that have successfully preserved the fetus to continue pregnancy after the experience of in vitro circulation cardiac surgery.

The key to success depends on whether the surgery is timely, whether the many details of the mother’s fetal fetus can be implemented one by one during the operation and perioperative period, and whether each discipline technology participating in the treatment is mature.This is also the first maternal maternal maternal maternal maternal maternity carried out by the Guangzhou Severe Maternal Maternal Care Center.

On June 17, Alan, who was 38 weeks pregnant, had a child in the third hospital in Guangyi

According to Liu Shenghua, infectious endometritis is due to bacteria, fungi, and other microorganisms that enter the blood, deposit in the heart, and directly infect the endometrium.On the top, the closure of the valve is incomplete, which seriously affects the heart function.If it is not intervened in time, the infection will increase, causing heart failure and life -threatening.

Although the incidence of infectious heart endometritis is relatively low, it is often easy to misdiagnose and missed diagnosis in early onset. If it is not diagnosed or effective in time, it will lose the chance of surgery or even life -threatening.

For patients who have recently extracted, oral ulcers, lung infections or urinary tract infections, and diagnosis and treatment of trauma in the hospital, if repeated high fever, chest tightness discomfort, etc., you must go to a specialist hospital in time.

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