Myerson Saul G, Mitchell Andrew R J, Ormerod Oliver J M, Banning Adrian P
Oxford University Department of Cardiovascular Medicine, John Radcliffe Hospital, Oxford, UK.
J Heart Valve Dis. 2005 Mar;14(2):147-50.
Severe aortic stenosis in pregnancy creates several challenges for the physician. In recent years, balloon valvuloplasty has become more widely used, though the indications for its use in this setting are unclear. A review of the available evidence is presented, and a suggested management strategy illustrated.
Available literature on the subject was reviewed via Medline search and reference lists from the identified articles. Particular attention was paid to prediction of risk, management options and outcome. The data suggest the importance of early symptoms in determining management, as there is a high risk of complications if left untreated. This group should be considered for valvuloplasty, whereas asymptomatic patients are at low risk, and can be managed expectantly. This is illustrated with two contrasting cases from the authors' practice: the symptomatic patient underwent aortic balloon valvuloplasty as a palliative procedure, using transesophageal and minimal fluoroscopic guidance, with good medium-term results. Both patients required aortic valve replacement in the medium to long-term.
The use of aortic balloon valvuloplasty in pregnancy is useful as a palliative procedure, allowing deferral of valve replacement until after birth. Echocardiographic features alone are not enough to decide on management, and symptoms play a vital role in determining risk. The use of transesophageal echocardiography during the procedure significantly reduces fluoroscopy time.
妊娠期重度主动脉瓣狭窄给医生带来了诸多挑战。近年来，球囊瓣膜成形术的应用更为广泛，但其在这种情况下的使用指征尚不清楚。本文对现有证据进行了综述，并阐述了建议的管理策略。
通过Medline检索及所获文章的参考文献列表，对该主题的现有文献进行了综述。特别关注了风险预测、管理方案及结果。数据表明早期症状在确定治疗方案方面的重要性，因为若不治疗，并发症风险很高。对于有症状的患者应考虑行瓣膜成形术，而无症状患者风险较低，可进行观察性管理。作者临床实践中的两个对比病例说明了这一点：有症状的患者接受了主动脉球囊瓣膜成形术作为姑息治疗，采用经食管和最低限度的荧光透视引导，中期效果良好。两名患者在中长期均需要进行主动脉瓣置换。
妊娠期使用主动脉球囊瓣膜成形术作为姑息治疗是有用的，可将瓣膜置换推迟至产后。仅凭超声心动图特征不足以决定治疗方案，症状在确定风险方面起着至关重要的作用。术中使用经食管超声心动图可显著减少荧光透视时间。
