Open heart operation for a pregnant patient with Marfan syndrome

A 32-year-old woman with Marfan syndrome was diagnosed as annuloaortic ectasia and acute aortic dissection at 20 weeks of gestation. At 24 weeks of gestation, she got heart failure. Bentall's procedure was performed under cardiopulmonary bypass. Anesthesia was given using sevoflurane, midazolam and fentanyl. Normothermic high-flow high-pressure non-pulsatile perfusion was performed during cardiopulmonary bypass. We used dopamine, dobutamine, milrinone and nitroglycerin for weaning of cardiopulmonary bypass. Fetal heart rate was monitored, and was stable at 120 bpm throughout the operation. At 33 weeks of pregnancy a healthy baby was delivered by cesarian section.