Bowater Sarah E, Selman Tara J, Hudsmith Lucy E, Clift Paul F, Thompson Peter J, Thorne Sara A
Department of Cardiology, Queen Elizabeth Hospital NHS Foundation Trust, Birmingham, UK.
Congenit Heart Dis. 2013 Jul-Aug;8(4):302-7. doi: 10.1111/chd.12001. Epub 2012 Sep 12.
The right ventricle (RV) supports the systemic circulation in patients who have had an intraatrial repair of transposition of the great arteries or have congenitally corrected transposition. There is concern about the ability of a systemic RV to support the additional volume load of pregnancy, and previous studies have reported deterioration in RV function following pregnancy. However, conditions with a systemic RV are also associated with progressive RV dysfunction over time. To date, no study has examined whether the deterioration associated with pregnancy is due to the physiological changes of pregnancy itself, or is part of the known deterioration that occurs with time in these patients.
Women who had undergone pregnancy under the care of the Adult Congenital Heart Disease Unit at the Queen Elizabeth Hospital were retrospectively identified and matched to separate male and nulliparous female controls. Functional status (New York Health Association [NYHA]), RV function, and systemic atrioventricular valve regurgitation were recorded for each group at baseline, postpregnancy (or at 1 year for control groups) and at latest follow-up.
Eighteen women had 31 pregnancies (range 1-4) resulting in 32 live births. There were no maternal but one neonatal death. At baseline, there was no significant difference in NYHA class or RV function between pregnancy and control groups. In postpregnancy, there was a significant deterioration in the pregnant group alone for both NYHA class (P = 0.004) and RV function (P = 0.02). At latest follow-up, there was a significant deterioration in RV function in all three groups. There was still a reduction from baseline in NYHA of women who had undergone pregnancy (P = 0.014), which again was not seen in the controls groups.
This study suggests that pregnancy is associated with a premature deterioration in RV function in women with a systemic RV. These women are also more symptomatic, with a greater reduction in functional class compared with patients with a systemic RV who do not undergo pregnancy. This study will allow this cohort of women to be more accurately counseled as to the potential long-term risks of pregnancy.
右心室（RV）为接受过大动脉转位心房内修复术或先天性矫正型大动脉转位的患者的体循环提供支持。人们担心体循环右心室支持妊娠额外容量负荷的能力，先前的研究报告了妊娠后右心室功能的恶化。然而，体循环右心室的情况也与右心室功能随时间逐渐恶化有关。迄今为止，尚无研究探讨与妊娠相关的恶化是由于妊娠本身的生理变化，还是这些患者随时间发生的已知恶化的一部分。
回顾性确定在伊丽莎白女王医院成人先天性心脏病科接受妊娠护理的女性，并将其与单独的男性和未生育女性对照组进行匹配。在基线、妊娠后（或对照组为1年时）和最新随访时记录每组的功能状态（纽约心脏协会[NYHA]）、右心室功能和体循环房室瓣反流情况。
18名女性有31次妊娠（范围为1 - 4次），产下32名活产婴儿。有1例新生儿死亡，无孕产妇死亡。基线时，妊娠组和对照组在NYHA分级或右心室功能方面无显著差异。妊娠后，仅妊娠组的NYHA分级（P = 0.004）和右心室功能（P = 0.02）有显著恶化。在最新随访时，所有三组的右心室功能均有显著恶化。接受过妊娠的女性的NYHA分级仍较基线有所下降（P = 0.014），而对照组未出现这种情况。
本研究表明，妊娠与体循环右心室女性的右心室功能过早恶化有关。与未妊娠的体循环右心室患者相比，这些女性的症状也更明显，功能分级下降更大。这项研究将使这一女性群体能够更准确地了解妊娠潜在的长期风险。
