Department of Cardiology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.
Department of Cardiology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands; The Netherlands Heart Institute (ICIN), Utrecht, The Netherlands.
Int J Cardiol. 2017 Dec 15;249:145-150. doi: 10.1016/j.ijcard.2017.09.167. Epub 2017 Sep 22.
Women with repaired coarctation of the aorta (rCoA) are at risk of hypertensive disorders and other complications during pregnancy. Hypertensive disorders in pregnant women are associated with inadequate uteroplacental flow, which is related to adverse offspring outcome. The aim of this study was to investigate the relationship of maternal cardiac function, placental function and pregnancy complications in women with rCoA.
We included 49 pregnant women with rCoA and 69 controls from the prospective ZAHARA-studies (Zwangerschap bij Aangeboren HARtAfwijkingen, pregnancy in congenital heart disease). Clinical evaluation, echocardiography and uteroplacental Doppler flow (UDF) measurements were performed at 20 and 32weeks gestation. Univariable regression analysis was performed.
Comparison of rCoA and healthy women. In women with rCoA, tricuspid annular plane systolic excursion (TAPSE) decreased during pregnancy (25.7mm to 22.8mm, P=0.006). UDF indices and pregnancy complication rates were similar in both groups. Offspring of rCoA women had lower birth weight (3233g versus 3578g, P=0.001), which was associated with β-blocker use during pregnancy (β=-418.0, P=0.01). Association of cardiac function and UDF. Right ventricular (RV) function before pregnancy (TAPSE) and at 20weeks gestation (TAPSE and RV fractional area change) were associated with impaired UDF indices (umbilical artery pulsatility index at 20weeks β=-0.02, P=0.01, resistance index at 20 and 32weeks β=-0.01, P=0.02 and β=-0.02, P=0.01 and uterine artery pulsatility and resistance index at 20weeks gestation β=-0.02, P=0.05 and β=-0.01, P=0.02).
Women with rCoA tolerate pregnancy well. However, RV function is altered and is associated with impaired placentation.
患有修复后的主动脉缩窄（rCoA）的女性在怀孕期间有发生高血压疾病和其他并发症的风险。孕妇的高血压疾病与胎盘血流不足有关，而胎盘血流不足与不良的后代结局相关。本研究的目的是探讨 rCoA 女性的母体心功能、胎盘功能与妊娠并发症之间的关系。
我们纳入了来自前瞻性 ZAHARA 研究（Zwangerschap bij Aangeboren HARtAfwijkingen，先天性心脏病妊娠）的 49 名患有 rCoA 的孕妇和 69 名对照。在 20 周和 32 周妊娠时进行临床评估、超声心动图和胎盘血流（UDF）测量。进行单变量回归分析。
rCoA 与健康女性的比较。在 rCoA 女性中，三尖瓣环平面收缩期位移（TAPSE）在妊娠期间下降（25.7mm 降至 22.8mm，P=0.006）。两组的 UDF 指数和妊娠并发症发生率相似。rCoA 女性的后代出生体重较低（3233g 比 3578g，P=0.001），这与妊娠期间使用β受体阻滞剂有关（β=-418.0，P=0.01）。心功能与 UDF 的关系。妊娠前（TAPSE）和 20 周时（TAPSE 和右心室分数面积变化）的右心室（RV）功能与 UDF 指数受损相关（20 周时脐动脉搏动指数β=-0.02，P=0.01，20 周和 32 周时阻力指数β=-0.01，P=0.02 和β=-0.02，P=0.01，20 周时子宫动脉搏动和阻力指数β=-0.02，P=0.05 和β=-0.01，P=0.02）。
患有 rCoA 的女性能够很好地耐受妊娠。然而，RV 功能发生改变，并与胎盘功能不良有关。
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