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Cardiac surgery during pregnancy carries an extremely high fetal risk. When conducting anesthesia in the gravid patient care must be taken to avoid uterine contractions, and fetal hypoxia. Thus, in such cases, monitoring the fetal heart rate is of special importance, as early detection of fetal bradycardia can potentially prevent fetal harm. We present a mother in the 16th week of pregnancy with endocarditis of the aortic valve associated with NYHA IV stage heart failure undergoing successful mechanical aortic valve implantation and reconstruction of the anterior leaflet of the mitral valve. The surgery was remarkable for an episode of serious maternal circulatory failure which was treated with several cycles of reperfusion and ephedrine. Perioperative fetal heart rate monitoring was carried out using Doppler ultra-sound technology. There was no critical fetal bradycardia encountered in the intra and perioperative period. Birth was on term via vaginal delivery, with satisfactory weight and Apgar score. Dysmorphic face and multiple tarsal syndactylia were detected with accompanying partial dysgenesis of the corpus callosum on cranial ultrasound testing. These were attributed to an inherited gene mutation as a part of Pfeiffer syndrome, which, in fact, had familial aggregation on further investigation. Additionally, the newborn demonstrated symptoms of secondary hypadrenia possibly resulting from the serious maternal condition during the pregnancy, although the use of anesthetics in the 2nd trimester cannot be excluded as a cause. During our follow up, both the somatic and mental development of the child remained unaffected. No cognitive or learning disabilities were apparent.

Perioperative Fetal Monitoring during Acute Heart Valve Surgery in the 16th Week of Pregnancy: A Case Study with Follow up after Five Years