Keir Michelle, Bhagra Catriona, Vatenmakher Debra, Arancibia-Galilea Francisca, Jansen Katrijn, Toh Norihisa, Silversides Candice K, Colman Jack, Siu Samuel C, Sermer Mathew, Crean Andrew M, Wald Rachel M
1Toronto Congenital Cardiac Centre for Adults,Toronto General Hospital,University of Toronto,Toronto,Ontario,Canada.
2Division of Cardiology, Pregnancy and Heart Disease Program,Mount Sinai Hospital,Toronto,Ontario,Canada.
Cardiol Young. 2017 Oct;27(8):1529-1537. doi: 10.1017/S1047951117000658. Epub 2017 Apr 17.
Individuals with childhood-onset coronary artery anomalies are at increased risk of lifelong complications. Although pregnancy is thought to confer additional risk, a few data are available regarding outcomes in this group of women. We sought to define outcomes of pregnancy in this unique population.
We performed a retrospective survey of women with paediatric-onset coronary anomalies and pregnancy in our institution, combined with a systematic review of published cases. We defined paediatric-onset coronary artery anomalies as congenital coronary anomalies and inflammatory arteriopathies of childhood that cause coronary aneurysms. Major cardiovascular events were defined as pulmonary oedema, sustained arrhythmia requiring treatment, stroke, myocardial infarction, cardiac arrest, or death.
A total of 25 surveys were mailed, and 20 were returned (80% response rate). We included 46 articles from the literature, which described cardiovascular outcomes in 82 women (138 pregnancies). These data were amalgamated for a total of 102 women and 194 pregnancies; 59% of women were known to have paediatric-onset coronary artery anomalies before pregnancy. In 23%, the anomaly was unmasked during or shortly after pregnancy. The remainder, 18%, was diagnosed later in life. Major cardiovascular events occurred in 14 women (14%) and included heart failure (n=5, 5%), myocardial infarction (n=7, 7%), maternal death (n=2, 2%), cardiac arrest secondary to ventricular fibrillation (n=1, 1%), and stroke (n=1, 1%). The majority of maternal events (13/14, 93%) occurred in women with no previous diagnosis of coronary disease.
Women with paediatric-onset coronary artery anomalies have a 14% risk of adverse cardiovascular events in pregnancy, indicating the need for careful assessment and close follow-up. Prospective, multicentre studies are required to better define risk and predictors of complications during pregnancy.
患有儿童期发病的冠状动脉异常的个体终身发生并发症的风险增加。尽管妊娠被认为会带来额外风险，但关于这组女性妊娠结局的数据却很少。我们试图明确这一特殊人群的妊娠结局。
我们对本院患有儿童期发病的冠状动脉异常并妊娠的女性进行了一项回顾性调查，并对已发表病例进行了系统综述。我们将儿童期发病的冠状动脉异常定义为先天性冠状动脉异常以及导致冠状动脉瘤的儿童期炎性动脉病变。主要心血管事件定义为肺水肿、需要治疗的持续性心律失常、中风、心肌梗死、心脏骤停或死亡。
共邮寄了25份调查问卷，20份被退回（回复率80%）。我们纳入了文献中的46篇文章，这些文章描述了82名女性（138次妊娠）的心血管结局。这些数据合并后共有102名女性和194次妊娠；59%的女性在妊娠前已知患有儿童期发病的冠状动脉异常。23%的女性在妊娠期间或妊娠后不久发现了异常。其余18%在生命后期被诊断出来。14名女性（14%）发生了主要心血管事件，包括心力衰竭（5例，5%）、心肌梗死（7例，7%）、孕产妇死亡（2例，2%）、心室颤动继发心脏骤停（1例，1%）和中风（1例，1%）。大多数孕产妇事件（13/14，93%）发生在既往无冠心病诊断的女性中。
患有儿童期发病的冠状动脉异常的女性妊娠期间发生不良心血管事件的风险为14%，这表明需要进行仔细评估和密切随访。需要开展前瞻性多中心研究，以更好地明确妊娠期间并发症的风险和预测因素。
