Maternal-Fetal Interactions in Fetal Cardiac Surgery

doi:10.1016/j.athoracsur.2005.06.053

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Original article: Cardiovascular

Maternal-Fetal Interactions in Fetal Cardiac Surgery

Pirooz Eghtesady, MD, PhD^a^,

b^,

_*, Joseph A. Sedgwick^c, Jennifer L. Schenbeck, BS, RVT^a, Christopher Lam^c, John Lombardi, CCP^a^,

b, Robert Ferguson, CCP, CCT^a^,

b, Aimee Gardner, CCP^a^,

b, Jerri McNamara, BA, BS^a^,

b, Peter Manning, MD^a^,

b

^a Division of Cardiothoracic Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
^b Department of Surgery, University of Cincinnati, Cincinnati, Ohio
^c Department of Biomedical Engineering, University of Cincinnati, Cincinnati, Ohio

Accepted for publication June 20, 2005.

^_* Address correspondence to Dr Eghtesady, Division of Cardiothoracic Surgery, Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave, Cincinnati, OH 45229-3032 (Email: pirooz.eghtesady{at}cchmc.org).

Presented at the Forty-first Annual Meeting of The Society of Thoracic Surgeons, Tampa, FL, Jan 24–26, 2005.

BACKGROUND: We examined potential maternal-fetal interactions during fetalcardiopulmonary bypass. these interactions, not previously described,may significantly influence attempts at fetal cardiac surgery.

METHODS: Eight fetal sheep underwent cardiopulmonary bypass (5 singletons,3 twins; 100–109 days) for 60 minutes using a centrifugalmicrocircuit (20 mL prime), and the placenta as oxygenator.We measured maternal hemodynamics, arterial blood gases, andchanges in blood flow to the gravid uterus using bilateral uterineartery flow probes. Maternal measurements were correlated tofetal hemodynamics, blood gases, and umbilical blood flows.After bypass, fetuses were followed for 60 minutes.

RESULTS: Decreases in uterine blood flow occurred without changes inmaternal hemodynamics or arterial blood gases, but were associatedwith worsening fetal arterial blood gases (pH decreased from7.2 ± 0.2 to 7.0 ± 0.1, partial pressure of carbondioxide increased 45.6% and partial pressure of oxygen decreased15.4%). Changes in maternal hemodynamics (decreased systolicblood pressure [17.5%, SD = 11] and decreased diastolic bloodpressure [20.3%, SD = 15]) were only noted when uterine bloodflows decreased by greater than 38.2% (SD = 26). Correctionof maternal hypocalcemia (0.89g/dL, SD = 0.1) led to improveduterine artery flows (28.3% increase, SD = 30). Finally, fetalsternotomy, cannulation, and cardiopulmonary bypass each decreaseduterine artery flows by 27.5% (SD = 18), 31.0% (SD = 26), and39.7% (SD = 25), respectively. Similar changes were not observedin the nonbypass twin.

CONCLUSIONS: Significant changes in uterine blood flow can occur during fetalcardiopulmonary bypass support without apparent changes in maternalhemodynamics or arterial blood gases. These changes imply aunique transplacental maternal-fetal interaction. Limited datafrom the twin fetus suggest a localized mechanism involvingonly the segment of placenta exposed to extracorporeal circulation.

This article has been cited by other articles:

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