Hypoxic-ischemic fetal insult resulting from maternal aortic root replacement, with normal fetal heart rate at term

• Published in: American journal of obstetrics and gynecology Vol. 179; no. 3; pp. 825 - 827
• Main Authors: Mul, Theo F.M., van Herwerden, Lex A., Cohen-Overbeek, Titia E., Catsman-Berrevoets, C.E., Lotgering, Fred K.
• Format: Journal Article
• Language: English
• Published: Philadelphia, PA Mosby, Inc 01.09.1998; Elsevier
• Subjects: Adult; Aorta - surgery; Biological and medical sciences; Blood Vessel Prosthesis Implantation - adverse effects; cardiac surgery; cerebral palsy; deep hypothermia; Delivery, Obstetric; Diseases of mother, fetus and pregnancy; extracorporeal circulation; Female; fetal heart rate; Fetal Hypoxia - diagnostic imaging; Fetal Hypoxia - etiology; Fetus - blood supply; Gynecology. Andrology. Obstetrics; Heart Rate, Fetal - physiology; Humans; Ischemia - diagnostic imaging; Ischemia - etiology; Marfan's syndrome; Medical sciences; Pregnancy; Pregnancy. Fetus. Placenta; Reference Values; Ultrasonography, Prenatal; Marfan's syndrome; extracorporeal circulation; deep hypothermia; pregnancy; cerebral palsy; cardiac surgery; fetal heart rate; Pregnancy disorders; Cardiovascular disease; Marfan syndrome; Arterial disease; Vascular disease; Atrophy; Fetal diseases; Ischemia; Surgery; Systemic disease; Complication; Female; Fetus; Cerebrovascular disease; Human; Postoperative; Connective tissue disease; Nervous system diseases; Oxygen; Elastic tissue disease; Cerebral disorder; Genetic disease; Case study; Heart rate; Treatment; Central nervous system disease; Hypoxia; Fetal distress; Aortic disease; Brain (vertebrata)
• ISSN: 0002-9378; 1097-6868
• DOI: 10.1016/S0002-9378(98)70094-8

A patient with Marfan’s syndrome was seen at 29 weeks’ gestation with acute aortic dissection. She underwent aortic root replacement under deep hypothermia and circulatory arrest. The fetal heart rate was ominous during surgery but recovered later. Serial ultrasonographic examinations showed progressive fetal brain atrophy. The patient was delivered at 38 weeks’ gestation of a girl weighing 2305 g, in whom severe spastic tetraplegia, absent psychomotor development, and therapy-resistant epilepsy developed. This is the first case to document progressive fetal brain atrophy after cardiac surgery in pregnancy. (Am J Obstet Gynecol 1998;179:825-7.)