Successful use of deep hypothermic circulatory arrest (DHCA) during mid-term pregnancy

Abstract

Introduction Ascending aortic dissection (Type A) often requires deep hypothermic circulatory arrest (DHCA) for proper repair. It involves the use of cardiopulmonary bypass to achieve whole body cooling to a temperature of 18 degrees Celsius prior to the cessation of all circulation. This circulatory arrest then allows for repair of the aortic arch and/or cerebral vessels without cross-clamp. This technique is well described and has become standard practice in the treatment of Type A dissection. The use of DHCA during pregnancy, however, has seldom been described. Case description A 31-year-old female at 21 weeks gestation presented acutely to the emergency department with a Type A aortic dissection. She was taken emergently to the operating room and cardiopulmonary bypass was initiated via femoral arterial and central venous cannulation. Aortic repair was accomplished during a 25 minute period of DHCA. Destruction of her aortic root by the dissection included the right coronary ostium and required composite tissue valve and conduit replacement (Bio–Bentall) with right coronary saphenous vein bypass. Fetal ultrasound imaging obtained preoperatively and postoperatively demonstrated no changes in fetal heart tones or obvious evidence of fetal injury. She was subsequently discharged on postoperative day 4. Evaluation by obstetrics 8 weeks postoperatively (29 weeks gestation) revealed normal fetal growth. 4 months post operatively she delivered a full-term infant without any noticeable deficits. Conclusions The use of DHCA for type A aortic dissection is standard practice but its use during pregnancy has rarely been described. This case illustrates the use of DHCA during midterm pregnancy that resulted in an excellent outcome. Take home message DHCA can successfully be used during midterm pregnancy.