Maternal-Fetal Interactions in Fetal Cardiac Surgery

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Maternal-Fetal Interactions in Fetal Cardiac Surgery Pirooz Eghtesady, MD, PhD, Joseph A. Sedgwick, Jennifer L. Schenbeck, BS, RVT, Christopher Lam, John Lombardi, CCP, Robert Ferguson, CCP, CCT, Aimee Gardner, CCP, Jerri McNamara, BA, BS, Peter Manning, MD The Annals of Thoracic Surgery Volume 81, Issue 1, Pages 249-256 (January 2006) DOI: 10.1016/j.athoracsur.2005.06.053 Copyright © 2006 The Society of Thoracic Surgeons Terms and Conditions

Fig 1 Uterine artery flows vary with fetal cardiac surgery. A representative plot from one animal shows uterine artery flow of the operated horn throughout the study period. Surgical manipulations during the experimental period are indicated by arrows. The typical range of uterine artery flows was between 300 and 500 mL/minute throughout the entire surgical period, indicated by dashed horizontal lines. Open squares refer to time points of measurement. The Annals of Thoracic Surgery 2006 81, 249-256DOI: (10.1016/j.athoracsur.2005.06.053) Copyright © 2006 The Society of Thoracic Surgeons Terms and Conditions

Fig 2 Uterine artery blood flows in the operated horn before and after fetal surgical events: sternotomy (A), cannulation (B), and initiation of bypass (C). (□----□ = individual case; •—• = mean ± SD.) The Annals of Thoracic Surgery 2006 81, 249-256DOI: (10.1016/j.athoracsur.2005.06.053) Copyright © 2006 The Society of Thoracic Surgeons Terms and Conditions

Fig 3 Effects of sternotomy (A), cannulation (B), and initiation of bypass (C) on fetal arterial gases before and after these surgical events are shown. Values shown are the mean ± SD. Closed squares and diamonds refer to data points. The Annals of Thoracic Surgery 2006 81, 249-256DOI: (10.1016/j.athoracsur.2005.06.053) Copyright © 2006 The Society of Thoracic Surgeons Terms and Conditions

Fig 4 Effects of sternotomy (A), cannulation (B), and initiation of bypass (C) on maternal arterial gases before and after surgical manipulations of the fetus are shown. Values shown are the mean ± SD. Closed squares and diamonds refer to data points. The Annals of Thoracic Surgery 2006 81, 249-256DOI: (10.1016/j.athoracsur.2005.06.053) Copyright © 2006 The Society of Thoracic Surgeons Terms and Conditions

Fig 5 Effects of sternotomy (A), cannulation (B), and initiation of bypass (C) on maternal mean arterial pressure and heart rate are shown. The values shown are the mean ± SD. Closed squares and diamonds refer to data points. The Annals of Thoracic Surgery 2006 81, 249-256DOI: (10.1016/j.athoracsur.2005.06.053) Copyright © 2006 The Society of Thoracic Surgeons Terms and Conditions

Fig 6 Uterine artery flows before, during, and after bypass (10 minute intervals). Points of bypass initiation and termination are indicated by arrows. Closed diamonds refer to data points. The Annals of Thoracic Surgery 2006 81, 249-256DOI: (10.1016/j.athoracsur.2005.06.053) Copyright © 2006 The Society of Thoracic Surgeons Terms and Conditions

Fig 7 A representative pattern of uterine artery flows in a fetal twin nonoperated horn during surgical manipulations (indicated by arrows) of the twin fetus exposed to 60 minute bypass. Open squares refer to time points of measurement. The Annals of Thoracic Surgery 2006 81, 249-256DOI: (10.1016/j.athoracsur.2005.06.053) Copyright © 2006 The Society of Thoracic Surgeons Terms and Conditions