Greatorex Ben, Colebourn Claire, Ormerod Oliver
Department of Anaesthesia and Intensive Care, Raigmore Hospital, NHS Highlands, Inverness, UK.
Oxford University Hospitals, Oxford, UK.
J Intensive Care Soc. 2022 May;23(2):210-221. doi: 10.1177/1751143720978862. Epub 2021 Jan 5.
Cardiac disease remains the largest single cause of maternal death. Whilst uncommon, left ventricular failure during pregnancy and delivery can be devastating to both mother and child. Echocardiography can play a significant role in rapidly establishing a diagnosis, guiding initial therapy and then monitoring response.
The history, presentation and management of three cases of peri-partum left ventricular failure is examined: stress cardiomyopathy in a 34 year old with twins, left ventricular dysfunction secondary to pre-eclampsia in a 22 year old with a singleton pregnancy and a true peri-partum cardiomyopathy in a 42 year old with IVF twins. The defining risk factors, presenting characteristics and echocardiographical findings for each pathology are highlighted.
Echocardiography is playing an increasingly important role in the immediate assessment and management of left ventricular failure. This is especially true in the peri-partum woman, where establishing the correct therapy is both challenging and crucial due to the significant cardiovascular changes that occur around the time of delivery. To this end we believe that echocardiography should be rapidly available to guide the management of these patients by a multidisciplinary team made up of obstetricians, cardiologists, anaesthetists and intensive care physicians.
心脏病仍然是孕产妇死亡的最大单一原因。虽然并不常见，但妊娠和分娩期间的左心室衰竭对母婴双方都可能是灾难性的。超声心动图在快速确诊、指导初始治疗以及随后监测治疗反应方面可发挥重要作用。
对三例围产期左心室衰竭病例的病史、临床表现及治疗进行了研究：一例34岁怀有双胞胎的应激性心肌病患者，一例22岁单胎妊娠并发子痫前期继发左心室功能障碍的患者，以及一例42岁通过体外受精怀有双胞胎的真正围产期心肌病患者。突出了每种病理的决定性危险因素、临床表现特征及超声心动图检查结果。
超声心动图在左心室衰竭的即时评估和治疗中发挥着越来越重要的作用。在围产期女性中尤其如此，由于分娩前后会发生重大的心血管变化，确定正确的治疗方法既具有挑战性又至关重要。为此，我们认为应由产科医生、心脏病专家、麻醉师和重症监护医生组成的多学科团队应能迅速获得超声心动图检查结果，以指导对这些患者的治疗。
