Case report

Herein we present the case of a 33-year nulliparous woman at 21 weeks of gestation with mitral valve vegetation resulting from infective endocarditis. Due to the mother's critical condition caused by consecutive thromboembolic events, surgery with cardiopulmonary bypass was indicated. During surgery the fetus was monitored by a specialized obstetrician who repetitively measured the Doppler indices of the umbilical artery, Ductus venosus and uterine artery. Right after CO₂ was insufflated into the operating area, the Doppler monitoring showed an increased Pulsatility Index of the Umbilical artery right before fetal distress with bradycardia occurred. A subsequent maternal arterial blood gas analysis showed an acidosis with hypercapnia. Consequently, the CO₂ insufflation was stopped and the gas flow on the Heart Lung Machine increased. After regaining homeostasis of acidosis, the Doppler Indices and fetal heart rate recovered. The remaining surgery and postoperative course were uneventful. At the 37 weeks of gestation a healthy boy was delivered by Cesarean section and at the age of two years, the neurodevelopment was assessed, which indicated normal development in mental cognition, language and motoric. This report presents a periodic Doppler examination of the maternal and fetal circulation during surgery on CPB while also discussing the possible impact of fetal monitoring in managing open cardiac surgery in pregnancy.

中文翻译：

---

产妇心脏直视手术期间的胎儿多普勒监测：病例报告和多学科挑战的关键方面

案例报告

在此，我们介绍一例 33 岁未产妇，妊娠 21 周，因感染性心内膜炎导致二尖瓣赘生物。由于连续血栓栓塞事件导致母亲病情危重，需要进行体外循环手术。手术期间，专业产科医生对胎儿进行监测，重复测量脐动脉、静脉导管和子宫动脉的多普勒指数。就在CO₂被吹入手术区域之后，多普勒监测显示在发生心动过缓的胎儿窘迫之前脐动脉搏动指数增加。随后的母亲动脉血气分析显示酸中毒伴高碳酸血症。因此，停止CO ₂吹入并且心肺机上的气体流量增加。酸中毒恢复稳态后，多普勒指数和胎心率恢复。剩下的手术和术后过程都很顺利。妊娠 37 周时，一名健康男孩通过剖腹产产下，两岁时对神经发育进行了评估，结果表明心理认知、语言和运动发育正常。本报告介绍了CPB 手术期间对母体和胎儿循环的定期多普勒检查，同时还讨论了胎儿监测的可能影响管理妊娠期心脏直视手术。