Carro-Jiménez Eric J, López José E
Department of Medicine, Cardiology Section, University of Puerto Rico School of Medicine, San Juan, Puerto Rico.
Bol Asoc Med P R. 2005 Oct-Dec;97(4):328-33.
Primary pulmonary hypertension (PPH) is a disorder intrinsic to the pulmonary vascular bed characterized by sustained elevation in pulmonary artery pressure and pulmonary vascular resistance with normal pulmonary artery wedge pressure, in the absence of a known cause. Cardiovascular disorders are the most common cause of morbidity and mortality in pregnant women. Risk is so great with some cardiovascular abnor-malities that recommendation of avoidance or interruption of pregnancy is supportable, one of these conditions is pulmonary hypertension. In this article two patients with primary pulmonary hypertension who sustained two pregnancies each are described. Both patients had uneventful pregnancies and deliveries, with all neonates surviving. When evaluating primary pulmonary hypertension and pregnancy, early studies reported a maternal mortality rate as high as 50%. More recent studies report a maternal mortality of 30%. In this article, cases of primary pulmonary hypertension undergoing pregnancy from 1978 to 2005 were reviewed, revealing a 22% maternal mortality for the total number of pregnancies. Despite advances in treatment, primary pulmonary hypertension continues to carry considerable maternal morbidity and mortality, and prevention of pregnancy is still the main recommendation. Early diagnosis and treatment is critical and a multi-disciplinary approach is required when dealing with a patient with PPH who desires to continue pregnancy.
原发性肺动脉高压（PPH）是一种肺血管床的内在疾病，其特征为肺动脉压力和肺血管阻力持续升高，而肺动脉楔压正常，且无已知病因。心血管疾病是孕妇发病和死亡的最常见原因。某些心血管异常的风险极大，以至于建议避免或终止妊娠是合理的，其中一种情况就是肺动脉高压。本文描述了两名原发性肺动脉高压患者，她们各自经历了两次妊娠。两名患者的妊娠和分娩过程均顺利，所有新生儿均存活。在评估原发性肺动脉高压与妊娠时，早期研究报告的孕产妇死亡率高达50%。最近的研究报告孕产妇死亡率为30%。本文回顾了1978年至2005年期间原发性肺动脉高压患者妊娠的病例，发现所有妊娠的孕产妇死亡率为22%。尽管治疗取得了进展，但原发性肺动脉高压仍然导致相当高的孕产妇发病率和死亡率，预防妊娠仍然是主要建议。早期诊断和治疗至关重要，在处理希望继续妊娠的PPH患者时需要采取多学科方法。
