Oakley C M
Department of Medicine (Clinical Cardiology), Hammersmith Hospital and Royal Postgraduate Medical School, London, UK.
Can J Cardiol. 1990 May;6 Suppl B:3B-9B.
Heart disease is the most important nonobstetric cause of maternal death; however, most young women with heart disease do well during pregnancy. If the physician is uncertain of the effects of pregnancy on a particular heart condition, needless restrictions may be imposed. The main hazards are: pulmonary edema when it occurs suddenly in mitral stenosis; pulmonary hypertension (because pulmonary vascular disease tends to be exacerbated by pregnancy); infective endocarditis (this is rare); and fulminating peripartum cardiomyopathy. The practical management of the pregnant patient with various concomitant heart conditions (congenital heart disease, pulmonary hypertension, rheumatic heart disease, anticoagulants and artificial valves, constrictive pericarditis, kyphoscoliosis, Marfan's syndrome, mitral prolapse, hypertrophic cardiomyopathy, dilated cardiomyopathy, infective endocarditis, and arrhythmias) is discussed. An absolute indication for therapeutic abortion is severe pulmonary vascular disease; discretionary indications include 'chronic thromboembolic pulmonary hypertension,' cardiomyopathies (depending on the hemodynamic disturbance), and Marfan's syndrome.
心脏病是孕产妇死亡最重要的非产科原因；然而，大多数患有心脏病的年轻女性在孕期情况良好。如果医生不确定怀孕对某种特定心脏状况的影响，可能会施加不必要的限制。主要风险有：二尖瓣狭窄时突然发生的肺水肿；肺动脉高压（因为妊娠往往会使肺血管疾病加重）；感染性心内膜炎（这种情况很少见）；以及暴发性围产期心肌病。本文讨论了患有各种合并心脏疾病（先天性心脏病、肺动脉高压、风湿性心脏病、抗凝剂与人工瓣膜、缩窄性心包炎、脊柱后侧凸、马方综合征、二尖瓣脱垂、肥厚型心肌病、扩张型心肌病、感染性心内膜炎和心律失常）的孕妇的实际管理。治疗性流产的绝对指征是严重的肺血管疾病；可酌情考虑的指征包括“慢性血栓栓塞性肺动脉高压”、心肌病（取决于血流动力学紊乱情况）和马方综合征。
