medalphabetМедицинский алфавитMedical alphabet2078-56312949-2807ООО «Альфмед»10.33667/2078-5631-2019-3-25(400)-49-52medalphabet-1170Research ArticleСтатьиОдномоментное родоразрешение путем кесарева сечения и репротезирование митрального клапана у первородящей 36-летней пациентки (клинический случай)Momentary cesarean delivery and mitral valve reprosthetics in 36-year-old primiparous patient (clinical case)БазылевВ. В.BazylevV. V.

д. м. н., врач — сердечно-сосудистый хирург, гл. врач

г. Пенза

Penza

ЕвдокимовМ. Е.EvdokimovM. E.

к. м. н., врач — анестезиолог-реаниматолог, зав. отделением анестезиологии и реанимации

г. Пенза

Penza

ПантюхинаМ. А.PantyukhinaM. A.

врач отделения анестезиологии и реанимации

г. Пенза

Penza

ФГБУ «Федеральный центр сердечно-сосудистой хирургии» Минздрава РоссииРоссияFederal Centre for Cardiovascular SurgeryRussian Federation201919112019325Современная гинекология4952Copyright © Базылев В.В., Евдокимов М.Е., Пантюхина М.А., 20192019Базылев В.В., Евдокимов М.Е., Пантюхина М.А.Bazylev V.V., Evdokimov M.E., Pantyukhina M.A.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.med-alphabet.com/jour/article/view/1170

В статье представлен клинический опыт лечения 36-летней беременной первородящей пациентки, ранее, в 25-летнем возрасте, перенесшей протезирование митрального клапана (МК) двухстворчатым механическим протезом «МедИнж № 21» (Россия). Женщина поступила в стационар на 29-й неделе беременности с клиникой декомпенсации сердечной недостаточности —  отека легких на фоне дисфункции (паннуса) протеза МК. Пациентке были выполнены родоразрешение путем кесарева сечения (КС) и репротезирование МК механическим протезом МедИнж № 29. После извлечения плода (живая недоношенная девочка весом 1 180 г с оценкой по шкале Апгар 7/7) с целью предотвращения послеродового маточного кровотечения на фоне предстоящей гепаринизации выполнена перевязка внутренних подвздошных артерий. Время искусственного кровообращения (ИК) составило 89 минут, ишемии миокарда (ИМ) —  64 минуты. Перфузия проводилась в нормотермическом режиме. Ранний послеоперационный период осложнился кровотечением из полости перикарда. Мать была выписана из стационара в удовлетворительном состоянии на 17-е сутки, ребенок в связи с недоношенностью был переведен для выхаживания в специализированное неонатальное отделение и выписан из стационара в удовлетворительном состоянии на 30-е сутки. Детородная функция матери была сохранена.

This clinical case report represents our experience of treatment of 36 y. o. pregnant female patient who was previously undergone mitral valve replacement as she was 25. The operation was performed with the use of two leaflet mechanical prosthesis ‘MedEng No. 21’ (Russia). The patient was admitted to our hospital at 29th week of gestation with the signs of heart failure and pulmonary congestion because of prosthetic valve dysfunction. Delivery was performed by Caesarean section followed by mitral valve reprosthetics. In order to stop obstetric bleeding before heparin injection internal iliac arteries was ligated. Total time of extracorporeal circulation was 89 minutes, and myocardial ischemia — 64 minutes. Normothermic perfusion was performed. Mother and newborn were discharged from the hospital in a normal stable state. The childbearing ability of the mother was preserved.

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The authors declare that there are no conflicts of interest present.