Ou Q T, Lu J K, Zhang J, Chen Y, Li Q, Zhang J L
Department of Surgical Intensive Care Unit, Beijing Anzhen Hospital, Capital Medical University, Beijing 100029, China.
Zhonghua Nei Ke Za Zhi. 2017 Nov 1;56(11):827-832. doi: 10.3760/cma.j.issn.0578-1426.2017.11.010.
To investigate the perinatal outcome, risk factors and long-term outcome of pregnancy complicated with pulmonary arterial hypertension(PAH) and congenital heart diseases (CHD). Clinical data of 110 pregnant women who were diagnosed as PAH-CHD were retrospectively analyzed in the Department of Obstetrics and Gynecology and Surgical Intensive Care Unit at Beijing Anzhen Hospital from 2004 to 2013. The survival and treatment status were followed up. 110 subjects consisted of 11 mild PAH, 33 moderate and 66 severe ones. The incidences of deterioration in New York Heart Association (NYHA) classes (≥2) during pregnancy, respiratory failure, pulmonary hypertension crisis and arrhythmia were 25.5% (28/110), 7.3% (8/110), 10.0% (11/110), 10.0% (11/110) respectively. Among them, the difference of deterioration in NYHA classes (≥2) during pregnancy among the three groups was statistically significant. A total of 8 (7.3%) maternal deaths occurred during hospitalization, all of whom were severe PAH cases. Multivariate analysis showed that pulmonary artery systolic pressure was a risk factor of perioperative death (=1.042, =0.005). There were 55 cases (50.0%) of term delivery, and 35 cases (31.8%) of iatrogenic abortion. The proportion of term delivery in the severe PAH group was significantly lower. The proportion of iatrogenic abortion and small for gestational age infant (SGA) were higher in severe group. The incidence of neonatal malformations was 8.0% (6/75). The follow-up rate was 61.8% (63/102). Sudden death was reported in a parturient a few days after discharge. The remaining 62 patients survived during follow-up, while 53 patients (85.5%) were functional class (FC) Ⅰ-Ⅱ, 9 (14.5%) were FC Ⅲ-Ⅳ at follow-up. The cardiac function deterioration during pregnancy was not significantly correlated with long-term deterioration (=0.767). Perinatal mortality and the incidence of maternal and fetal adverse events were high in pregnancy with PAH-CHD. Pulmonary artery systolic pressure is a major risk factor for perioperative mortality in pregnant women. PAH-CHD woman had good overall outcome after puerperium.
探讨妊娠合并肺动脉高压（PAH）和先天性心脏病（CHD）的围产期结局、危险因素及远期结局。回顾性分析2004年至2013年在北京安贞医院妇产科及外科重症监护病房诊断为PAH-CHD的110例孕妇的临床资料。对其生存及治疗情况进行随访。110例受试者中，轻度PAH 11例，中度33例，重度66例。孕期纽约心脏协会（NYHA）分级恶化（≥2级）、呼吸衰竭、肺动脉高压危象及心律失常的发生率分别为25.5%（28/110）、7.3%（8/110）、10.0%（11/110）、10.0%（11/110）。其中，三组孕期NYHA分级恶化（≥2级）情况差异有统计学意义。住院期间共发生8例（7.3%）孕产妇死亡，均为重度PAH病例。多因素分析显示，肺动脉收缩压是围手术期死亡的危险因素（=1.042，=0.005）。足月分娩55例（50.0%），医源性流产35例（31.8%）。重度PAH组足月分娩比例显著降低。重度组医源性流产及小于胎龄儿（SGA）比例较高。新生儿畸形发生率为8.0%（6/75）。随访率为61.8%（63/102）。1例产妇出院数天后猝死。其余62例患者随访期间存活，随访时53例（85.5%）心功能分级（FC）为Ⅰ-Ⅱ级，9例（14.5%）为FCⅢ-Ⅳ级。孕期心功能恶化与远期恶化无明显相关性（=0.767）。PAH-CHD妊娠围产期死亡率及母婴不良事件发生率高。肺动脉收缩压是孕妇围手术期死亡的主要危险因素。PAH-CHD产妇产后总体结局良好。
