Pregnancy and Cardiac Surgery a Practical Guide

Pregnancy and Cardiac Surgery is a compelling exploration of one of the rare but profoundly challenging scenarios in clinical practice — performing open-heart surgery on a pregnant woman.
Combining storytelling with clinical insight, this chapter opens with vivid case vignettes that bring the emotional and ethical complexity to life: a young woman with mechanical valve thrombosis in her second trimester, another with progressive aortic dissection threatening both her life and her child’s.

From these human stories, the discussion flows into structured analysis — the maternal and fetal risks, hemodynamic and perfusion challenges, and timing of surgery. It reviews the current AHA/ACC and ESC guidelines, emphasizing when surgery is unavoidable versus when medical or percutaneous management may be safer.

The chapter delves into cardiopulmonary bypass (CPB) management during pregnancy, highlighting strategies for optimal perfusion pressure, temperature regulation, oxygen delivery, and avoidance of uterine hypoperfusion. Considerations such as normothermic CPB, high-flow circuits, and fetal monitoring are discussed in context of both evidence and clinical experience.

Written for cardiac surgery fellows and clinicians, it blends academic precision with real-world reasoning — acknowledging that every decision during pregnancy involves balancing risk, timing, and compassion.
Ultimately, this chapter teaches that cardiac surgery in pregnancy is not merely a technical challenge but a moral and physiological balancing act — demanding teamwork, vigilance, and humanity at every step.