Monteiro André Viveiros, Rebelo Joana, Patricio Lino, Campos Ana, Borges Augusta, Ferreira Rui Cruz
J Heart Valve Dis. 2015 May;24(3):368-75.
The population of pregnant women with valvular heart disease (VHD), and in particular with valvular heart prostheses (VHPs), represents a unique patient group where data are scarce, and where there is an increased risk for adverse maternal and obstetric events. The study aim was to assess the experience of a tertiary center with regards to cardiac and pregnancy outcomes in women with VHD, comparing VHPs with other VHD pathologies.
A retrospective analysis of 84 pregnancies in women with VHD (mean age 27.5 ± 5.5 years) was carried out over a 10-year period. Twenty-three pregnancies with VHPs (group A) and 61 with other VHD pathologies (group B) were identified and their cardiac, obstetric, and neonatal outcomes evaluated.
At the start of pregnancy, group A included more patients with an impaired left ventricular ejection fraction (LVEF) (15.8% versus 3.9%, p = 0.014), with a previous history of cardiac medication (82.6% versus 29.5%, p = 0.000), and with arrhythmic or ischemic events (18.2% versus 4.9%, p = 0.076). A deterioration in NYHA functional class was the most common cardiac complication (8.3%), and in 7.1% of patients it was necessary to initiate some form of cardiac medication. No maternal deaths were recorded. Group A presented significantly more hemorrhagic and thrombotic complications; all of these events were in women receiving low-molecular-weight heparin. There were 95.5% live births, with a medium birth weight of 3068 ± 498 g. In the VHP group there was also a higher incidence of spontaneous abortion (26.1 versus 3.3, p = 0.005), newborns small for gestational age (30.0 versus 0.4, p = 0.07) and mean Apgar score < 7 (16.7 versus 0.0, p = 0.031). Warfarin embryopathy was observed in one case.
With the multidisciplinary care provided, pregnancy was relatively well tolerated and successful. However, the presence of a VHP remains a challenging condition that is associated with elevated maternal and fetal morbidity. A worse baseline cardiac status of the mother, as well as anticoagulation issues, were determinants for these findings.
患有心脏瓣膜病（VHD），尤其是心脏瓣膜假体（VHP）的孕妇群体是一个独特的患者群体，相关数据稀缺，且孕产妇和产科不良事件风险增加。本研究旨在评估一家三级中心在患有VHD的女性心脏及妊娠结局方面的经验，比较VHP与其他VHD病理情况。
对10年间84例患有VHD的女性（平均年龄27.5±5.5岁）的妊娠情况进行回顾性分析。确定了23例有VHP的妊娠（A组）和61例有其他VHD病理情况的妊娠（B组），并评估了她们的心脏、产科和新生儿结局。
妊娠开始时，A组左心室射血分数（LVEF）受损的患者更多（15.8%对3.9%，p = 0.014），有心脏用药史的患者更多（82.6%对29.5%，p = 0.000），有心律失常或缺血性事件的患者更多（18.2%对4.9%，p = 0.076）。纽约心脏协会（NYHA）心功能分级恶化是最常见的心脏并发症（8.3%），7.1%的患者需要开始某种形式的心脏用药。未记录到孕产妇死亡。A组出现的出血和血栓形成并发症明显更多；所有这些事件均发生在接受低分子量肝素治疗的女性中。活产率为95.5%，平均出生体重为3068±498克。VHP组自然流产发生率也更高（26.1对3.3，p = 0.005），小于胎龄儿发生率更高（30.0对0.4，p = 0.07），平均阿氏评分<7分的发生率更高（16.7对0.0，p = 0.031）。观察到1例华法林胚胎病。
通过提供多学科护理，妊娠耐受性相对良好且较为成功。然而，VHP的存在仍然是一个具有挑战性的情况，与孕产妇和胎儿发病率升高相关。母亲较差的基线心脏状况以及抗凝问题是这些结果的决定因素。
