Erol ŞENER, Mete HIDIROĞLU, Aslıhan KÜÇÜKER

GEBELİKTE KALP HASTALIKLARI VE KALP CERRAHİSİ CARDIAC

Amaç: Gebelikte kalp hastalıkları, maternal mortalite ve morbiditenin önemli sebeplerinden birisidir. Gebelikte oluşan, dolaşan volüm ve kardiyak outputun artması, vasküler rezistansın düşmesi ve hiperkoagülasyon gibi fizyolojik hemodinamik değişiklikler, daha önce stabil olan bir hastanın kötüleşmesine yol açabilir. Yine de gebelik döneminde kalp cerrahisi çok sık gerekli olmamaktadır. Gebeliklerin sadece %1-4ünde maternal kalp hastalığı ile komplike olur ve bunların çoğunluğunda da medikal tedavi yeterli olmaktadır. Gebelikte uygulanan kalp cerrahisi çoğunlukla ekstrakorporeal dolaşım kullanımı gerektirdiğinden, anne ve bebek için hayati tehlike oluşturan durumlarda, bebeği koruyucu yaklaşımlar ön planda tutularak cerrahi yapılması tercih edilmelidir. Gebelik döneminde kalp hastalığı olan ve kalp cerrahisi yapılması gereken hastalar farklı uzmanlık alanlarının beraber çalışmasını gerektirir; kalp cerrahları, kardiyologlar, obstetrisyenler ve anesteziyologların yakın takibi ve iletişimi mutlaka olmalıdır. Derleme gebelerde kardiyovasküler perspektiften değerlendirmektedir.

DISEASES AND CARDIAC SURGERY DURING PREGNANCY

Aim: Cardiac diseases during pregnancy is one of the most important reasons of maternal mortality and morbidity. The physiological cardiovascular changes during pregnancy like increasing volume and cardiac output, decrease in cardiovascular resistance and hypercoagulation, may lead to decompensation of a stabilized patient. Even so, the need for cardiac surgery during pregnancy is rare. Only %1-4 of pregnancies are complicated by maternal cardiac disease and most of these can be managed with medical therapy alone. Since most of the cardiac surgical approaches required during pregnancy is performed via cardiopulmonary bypass, it is of utmost importance to apply management strategies to protect the baby. Pregnant women with surgical cardiac disease require close collaboration between different areas of expertise; cardiovascular surgeons, cardiologists, obstetricians and anesthesiologists should follow closely and communicate to each other. The present review is to overlook pregnant patients in cardiac surgical perspective.

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