Liu J Y, Tan W K, Tan E L, Tan J L, Tan L K
Singapore General Hospital, Singapore, Singapore.
Obstet Med. 2017 Jun;10(2):88-92. doi: 10.1177/1753495X16678487. Epub 2016 Nov 21.
Medical advances have increased survival of patients with congenital heart disease. However, cardiac disease in pregnancy carries significant maternal and fetal risks, posing enormous challenges to obstetricians. Cyanotic congenital heart disease is associated with maternal complications such as arrhythmias, thromboembolic events and death. Fetal complications include small for gestational age, miscarriage and prematurity. Cyanotic congenital heart disease patients who continue their pregnancies require holistic multidisciplinary team care with early and coordinated planning for delivery. Management of such patients include early counseling regarding pregnancy-associated risks, close monitoring of their cardiac function and regular scanning for fetal assessment. Choice of anesthesia for these patients requires meticulous planning to achieve a favorable balance between systemic and pulmonary vascular resistance, ensuring minimal change in right-to-left shunting. We report a case of a successfully managed pregnancy in a patient with complex congenital heart disease and a single ventricle of left ventricle morphology.
医学进步提高了先天性心脏病患者的生存率。然而,妊娠合并心脏病会给母婴带来重大风险,给产科医生带来巨大挑战。紫绀型先天性心脏病与母体并发症相关,如心律失常、血栓栓塞事件和死亡。胎儿并发症包括小于胎龄儿、流产和早产。继续妊娠的紫绀型先天性心脏病患者需要多学科综合团队的全面护理,并尽早进行协调一致的分娩计划。对此类患者的管理包括早期提供与妊娠相关风险的咨询、密切监测其心功能以及定期进行超声检查以评估胎儿情况。为这些患者选择麻醉需要精心规划,以在体循环和肺循环血管阻力之间实现良好平衡,确保右向左分流的变化最小。我们报告了一例成功管理的妊娠病例,该患者患有复杂先天性心脏病且左心室形态为单心室。