Emergency tricuspid valve replacement during pregnancy

A 36 year-old intravenous drug user at 19 weeks’ gestation required emergency tricuspid valve replacement for severe tricuspid regurgitation and cardiogenic shock refractory to medical therapy. Normothermic, pulsatile, high-flow, and pressure cardiopulmonary bypass (CPB) was used in the absence of fetal monitoring. Ten days postoperatively, the patient miscarried. She was discharged from hospital two months following surgery. High-flow (> 3.0 L/min2), high-pressure (> 70 mmHg), normothermic CPB using pulsatile flow and blood cardioplegia is thought to offer the best outcome to the fetus, although data to support these claims are not compelling.