Leśniak-Sobelga Agata, Tracz Wieslawa, KostKiewicz Magdalena, Podolec Piotr, Pasowicz Mieczystaw
Department of Cardiovascular Diseases, Institute of Cardiology, Jagiellonian University, School of Medicine, Ul. Pradnicka 80, 31-202 Cracow, Poland.
Int J Cardiol. 2004 Mar;94(1):15-23. doi: 10.1016/j.ijcard.2003.03.017.
The study aimed to compare the outcome of pregnancy in women with valvular heart diseases.
Two hundred and fifty-nine pregnant women with cardiac diseases, aged 18-42, were observed. Group I-158 patients with mitral valve disease: 30 patients with mitral stenosis; 44 patients with mitral regurgitation, 33 patients with combined mitral valve disease, 51 patients with mitral valve prolapse; Group II-54 patients with aortic valve disease: 32 patients with aortic stenosis, 22 with aortic regurgitation; Group III-47 patients after valve replacement (36 mechanical; 11 homograft valves). Medical history and physical examination, NYHA class assessment, ECG, and echocardiography were performed during consecutive trimesters of pregnancy and after delivery.
Clinical deterioration was observed in 38 patients-in 25 women of Group I, 6 women of Group II, and 7 women of Group III. Newborns outcome : 250 healthy (10 prematures, 12 with intrauterine growth retardation), 6 aborted, 2 stillbirths, 1 neonatal death. Method of delivery : 200 vaginally, 53 cesarean sections.
(1). Pregnants with critical mitral valve stenosis form a high-risk group of life-threatening complications. (2) In women with severe aortic stenosis, pregnancy could lead to sudden clinical status deterioration. (3) Cardiac complications can be expected in patients with left ventricular enlargement and its depressed function. (4) Key factors influencing successful course of pregnancy and labour in patients with prosthetic valves: adequate left ventricular function, properly functioning valves, and effective anticoagulation.
本研究旨在比较患有心脏瓣膜病的女性的妊娠结局。
观察了259例年龄在18 - 42岁之间的患有心脏病的孕妇。第一组 - 158例二尖瓣疾病患者：30例二尖瓣狭窄患者；44例二尖瓣反流患者，33例二尖瓣联合疾病患者，51例二尖瓣脱垂患者；第二组 - 54例主动脉瓣疾病患者：32例主动脉狭窄患者，22例主动脉反流患者；第三组 - 47例瓣膜置换术后患者（36例机械瓣膜；11例同种异体瓣膜）。在妊娠各期及分娩后进行病史采集、体格检查、纽约心脏协会（NYHA）心功能分级评估、心电图及超声心动图检查。
38例患者出现临床病情恶化 - 第一组25例女性，第二组6例女性，第三组7例女性。新生儿结局：250例健康（10例早产，12例宫内生长受限），6例流产，2例死产，1例新生儿死亡。分娩方式：200例经阴道分娩，53例剖宫产。
（1）重度二尖瓣狭窄的孕妇形成了一组有生命危险并发症的高危人群。（2）对于重度主动脉狭窄的女性，妊娠可能导致临床状态突然恶化。（3）左心室扩大及其功能降低的患者可能出现心脏并发症。（4）影响人工瓣膜患者妊娠和分娩成功过程的关键因素：足够的左心室功能、正常运作的瓣膜以及有效的抗凝治疗。
