Maternal Pulmonary Edema During Fetoscopic Surgery
Fetoscopy is a minimally invasive obstetric surgical
technique being used with increasing frequency to
palliate certain fetal diseases.1,2 The technique involves
the insertion of endoscopes percutaneously
into the uterus in order to allow manipulation of the
fetus(es) or placenta. Fetoscopy is used to facilitate
umbilical cord coagulation for the treatment of twin
reverse arterial perfusion (TRAP) sequence.3,4 In this
condition, a monochorionic twin pregnancy includes
an acardiac fetus or fetus with circulatory failure from
some other lethal anomaly, while the other fetus, the
“pump” twin, is anatomically normal. The acardiac or
failing fetus receives cardiac output via reversed flow
in the umbilical artery from the pump twin, placing
the latter at risk of high output cardiac failure. When
demise of the anatomically normal twin is predicted
from circulatory failure, interruption of blood flow in
the umbilical cord of the acardiac or failing twin can
save the pump twin by reversing the heart failure and
circulatory collapse.
An underlying principle of fetal surgery is that the
risk of anesthesia and surgery to the mother must be
minimal in relation to the benefit of the surgical
procedure for the fetus. Few reports describe maternal
complications of fetal surgical anesthesia.5–7 In many
respects, the anesthetic techniques for labor and delivery
differ from those of fetal surgery.3,4 We report a
case of pulmonary edema occurring in a mother
undergoing fetoscopic surgery for TRAP sequence.
The patient agreed to a case report being published as
part of the general consent for anesthesia.
胎儿镜检查术中孕妇急性肺水肿报道一例 胎儿镜检查是一种产科的微创手术技术,已经被广泛应用于明确诊断和缓解某些胎儿疾病。这项手术技术通过经皮将内镜置入子宫中,从而对胎儿及胎盘进行必要的诊断和手术处理。胎儿镜检查以往通常被用于促进脐带凝血,从而有效纠正双胞胎逆行性动脉灌注综合征(Twin Reverse Arterial Perfusion,TRAP)。TRAP常发生于同卵双生的双胞胎,其中一个胎儿为无心或者致命性的先天畸形引起的严重心力衰竭,而另一个胎儿则心血管解剖均完全正常,成为患儿的“泵”心,经脐带逆行性动脉灌注给患儿供血,但同时正常胎儿存在着心脏泵功能衰竭的巨大风险。解剖正常的胎儿一旦死亡,则这两个胎儿将同时循环衰竭。因此,阻断无心或者心力衰竭患儿脐带中的逆向血流能挽救正常胎儿的心功能及稳定循环状态。 这种先天性畸形的胎儿外科手术治疗的首要原则是将麻醉风险和手术对孕妇的影响降低到最小。目前尚未有报道因胎儿手术而引起的孕妇手术相关并发症。本文报道一例,在行TRAP患儿胎儿镜检查时发生的孕妇急性肺水肿的病例。 |