Zhang L L, Zhang J
Department of Obstetrics and Gynecology, Beijing Anzhen Hospital, Capital Medical University, Beijing 100029, China.
Zhonghua Fu Chan Ke Za Zhi. 2019 Jul 25;54(7):438-444. doi: 10.3760/cma.j.issn.0529-567x.2019.07.002.
To observe and analysis the changes of hemodynamic parameters and outcomes of pregnant women combined with congenital heart disease-pulmonary arterial hypertension (CHD-PAH). A prospective analysis of hemodynamic parameters of patients combined with CHD-PAH in Beijing Anzhen Hospital from January 2015 to December 2017 was carried out. Total 99 cases were divided into 4 groups based on systolic pulmonary arterial pressure (SPAP): mild group (SPAP 25-49 mmHg, 1 mmHg=0.133 kPa), moderate group (SPAP 50-79 mmHg), severe group (SPAP≥80 mmHg) and Eisenmenger syndrome group. (1) SPAP of all groups increased during gestation, and the growth rates had no statistical differences (0.05). The SPAP in each group decreased after termination but was still higher than the early pregnancy's SPAP. (2) CHD-PAH patients in moderate [2 cm(2) (1-5 cm(2)), 1.0 cm (-2.0 - 2.0 cm)], severe [5 cm(2) (3-9 cm(2)), -3.5 cm (-6.0 - 1.0 cm)] or Eisenmenger syndrome [5 cm(2) (3-6 cm(2)), -1.0 cm (-5.5 - 2.0 cm)] group had larger right atrium area and smaller left ventricular end-diastolic diameter than patients in mild group [1 cm(2) (-1 - 4 cm(2)), 3.0 cm (1.0-6.0 cm)], the differences were statistically significant (all 0.05). (3) Each group's SPAP/brachial arterial-systolic (BSAP) pressure continously increased during gestation. The SPAP/BSAP only decreased in patients in mild or moderate group after termination. However, the SPAP/BSAP kept rising in patients in severe group or Eisenmenger syndrome group. (4) CHD-PAH patients in severe or Eisenmenger syndrome group had worse cardiac function, in which the rates of Ⅲ-Ⅳ cardiac function were 61%(14/23) and 12/17, compared with patients in mild [8% (2/26)] and moderate [12%(4/33)] group, the differences were statistically significant (all 0.05). (5) The rates of medicine treatment, cesarean section were higher, the weeks of gestational termination were earlier and the newborn's weights were lower in patients in severe or Eisenmenger syndrome group, the differences were statistically significant (all 0.05). (1) SPAP keeps rising during gestation in all patients with CHD-PAH, and the SPAP decreases after termination but it's still higher than the early pregnancy's SPAP. This suggests that pregnancy would exacerbate these patients' heart problems, the risk should be fully considered before and during pregnancy. (2) Patients with severe CHD-PAH or combined with Eisenmenger syndrome have lager right atrium area, smaller left ventricular end-diastolic diameter, worse cardiac function, and bigger changes of hemodynamic, the incidence of adverse outcomes of mothers and children is also high, pregnancy should be avoided.
观察并分析合并先天性心脏病 - 肺动脉高压（CHD - PAH）孕妇的血流动力学参数变化及妊娠结局。对2015年1月至2017年12月在北京安贞医院合并CHD - PAH患者的血流动力学参数进行前瞻性分析。根据收缩期肺动脉压（SPAP）将99例患者分为4组：轻度组（SPAP 25 - 49 mmHg，1 mmHg = 0.133 kPa）、中度组（SPAP 50 - 79 mmHg）、重度组（SPAP≥80 mmHg）和艾森曼格综合征组。（1）所有组的SPAP在妊娠期均升高，增长率无统计学差异（P>0.05）。终止妊娠后各组SPAP均下降，但仍高于孕早期的SPAP。（2）中度[2 cm²（1 - 5 cm²），1.0 cm（ - 2.0 - 2.0 cm）]、重度[5 cm²（3 - 9 cm²）， - 3.5 cm（ - 6.0 - 1.0 cm）]或艾森曼格综合征[5 cm²（3 - 6 cm²）， - 1.0 cm（ - 5.5 - 2.0 cm）]组的CHD - PAH患者右心房面积较轻度组[1 cm²（ - 1 - 4 cm²），3.0 cm（1.0 - 6.0 cm）]大，左心室舒张末期内径较轻度组小，差异有统计学意义（均P<0.05）。（3）各组的SPAP/肱动脉收缩压（BSAP）在妊娠期持续升高。仅轻度或中度组患者终止妊娠后SPAP/BSAP下降。然而，重度组或艾森曼格综合征组患者的SPAP/BSAP持续上升。（4）重度或艾森曼格综合征组的CHD - PAH患者心功能较差，其Ⅲ - Ⅳ级心功能发生率分别为61%（14/23）和12/17，与轻度组[8%（2/26）]和中度组[12%（4/33）]患者相比，差异有统计学意义（均P<0.05）。（5）重度或艾森曼格综合征组患者药物治疗率、剖宫产率较高，终止妊娠孕周较早，新生儿体重较低，差异有统计学意义（均P<0.05）。（1）所有CHD - PAH患者妊娠期SPAP持续上升，终止妊娠后SPAP下降但仍高于孕早期的SPAP。这表明妊娠会加重这些患者的心脏问题，妊娠前后均应充分考虑风险。（2）重度CHD - PAH或合并艾森曼格综合征的患者右心房面积较大，左心室舒张末期内径较小，心功能较差，血流动力学变化较大，母婴不良结局发生率也高，应避免妊娠。
