Aybanu TUYGUN, Nurgül YURTSEVEN, Sabri DAĞSALI, Pelin KARACA, Abdullah Kemal TUYGUN

Gebelik ve açık kalp cerrahisi; anne ve fetus mortalitesini nasıl değiştirebiliriz?

Doğurganlık çağındaki kalp hastası kadınlarda gebelik ve buna bağlı yeni fizyolojik koşulların hastalara ek sorunlar getirdiği bilinmektedir. Gebe kadınlarda, kalp hastalarının büyük kısmını kalp kapak hastalığı olanlar oluşturur. Kalp kapak hastalıkları, günümüzde akut romatizmal ateşin kontrolü sonucu büyük ölçüde azaltılmışsa da, genç nüfusta, özellikle de gebelerde hala ciddi bir sorun olmaya devam etmektedir. Ayrıca prostetik kapak takılan doğurma yaşındaki kadınlardaki gebelik, anne ve fetusun yaşamı yönünden çok yakın takip gerektirmektedir. Prostetik kapak replasmanı yapılan ve daha sonra gebe kalan bir hastada, kapak disfonksiyonu veya endokardit gibi nedenlerle olası acil intrakardiyak ameliyatta, anne hayatı kadar fetusun hayatının korunması da şarttır. Bu gibi durumlarda anne ve fetal mortalitenin birbirine eklenmesiyle artan ameliyat mortalitesi, olayın ciddiyeti ve alınması gereken önlemlerin önemini çok çarpıcı bir şekilde ortaya koyar. Dünyada ancak sınırlı sayıdaki hastanın, sporadik olgular şeklinde bulunması ve klasikleşmiş bir yaklaşım yolunun hala tam olmaması konuyu tartışmalı hale getirmiştir. Özellikle kapak hastalığının sık görüldüğü az gelişmiş ya da gelişmekte olan ülkelerden yapılan yayınlar bu konuyla ilgili soru işaretlerine yanıt verecektir.

Pregnancy and open heart surgery: how can we change mother and fetus mortality

It is well-known that in women with cardiac disease, pregnancy and accompaniying physiologic changes might cause serious additional problems. Rheumatic valvular disease has historically been the most common type of heart disease in pregnant women. Although it has diminished significantly as a result of controls of acute rheumatic fever eradication, it still continues to be a serious problem in the young, pregnant women. Additionally, pregnant women, who have prosthetic valves need to be kept under surveillance for the lives of both the mother and the fetus. A likely emergent intracardiac operation which is caused by valve dysfunction and/or endocarditis in a pregnant patient with a prosthetic valve requires to take all precautions for the safety of both the lives of the mother and the fetus. The operative mortality rate increases by the associated maternal and fetal mortality and shows the necessary precautions and makes it striking how serious the situation is. That there are very limited number of cases and appear to be sporadic all over the world and there is no established well known classical management methods makes this situation controversial. Publications from the devoloping and undeveloped countries where valve disease is commonly seen will shed light on questions.

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