Wang H Y, Bao Z L, Yang D, Li Y N, Bu L, Ding W W, Zhang J
Department of Obstetrics and Gynecology, Beijing Anzhen Hospital, Capital Medical University, Obstetrics and Gynecology Center for Severe Cardiovascular Diseases, Beijing 100029, China.
Pediatric Cardiology Center, Beijing Anzhen Hospital, Capital Medical University, Beijing 100029, China.
Zhonghua Fu Chan Ke Za Zhi. 2022 May 25;57(5):332-338. doi: 10.3760/cma.j.cn112141-20220126-00049.
To investigate the clinical characteristics and pregnancy outcomes in pregnant women with left ventricular non-compaction (LVNC). The clinical data of seven pregnant women with LVNC from January 2011 to December 2021 in Beijing Anzhen Hospital,Capital Medical University were retrospectively analyzed, including age, gestational age of symptom first occured, LVNC history, clinical symptoms, New York Heart Association (NYHA) cardiac function class, echocardiography, blood brain natriuretic peptide (BNP), treatment and the maternal and fetal outcomes. Five cases were diagnosed before pregnancy, of which there were three women with medication; one case diagnosed in the month of pregnancy; one case diagnosed at 36 weeks of gestation. NYHA cardiac function was grade Ⅰ in four cases and grade Ⅱ in three cases before or during the first trimester of pregnancy. Of the five pregnant women who underwent echocardiography, there were one case of left ventricular insufficiency, three cases of mild left ventricular dysfunction and one case of normal left ventricular function before or during the first trimester of pregnancy. Of the five pregnant women to the second and third trimester of pregnancy, there were one case of grade Ⅳ, one case of grade Ⅲ, two cases of grade Ⅱ-Ⅲ and one case of grade Ⅱ in NYHA class ; three cases of left ventricular insufficiency, two cases of normal left ventricular function by echocardiography four cases had cardiac symptoms at 15-24 weeks of gestation and were treated with medication. In four cases, blood BNP increased to 214-1 197 ng/L during pregnancy, and were 89-106 ng/L after termination of pregnancy. There were 4 cases with arrhythmia. Indications for termination of pregnancy: LVNC complicated with heart failure in two cases, LVNC complicated with decreased cardiac function and threatened preterm birth in one case, complicated with pregnancy at full term in two cases, LVNC complicated with severe pulmonary hypertension in one case, and left ventricular dysfunction in one case. Cesarean section in four cases in the third-trimester, in one case in the second-trimester, and forceps curettage in two cases were taken. Two full-term infants,two preterm infants were born without LVNC. Women diagnosed with LVNC and low left ventricular ejection fraction before pregnancy are more prone to decreased cardiac function during pregnancy. Carrying out pregnancy risk assessment and strengthening the multi-disciplinary team management of high risk factors in pregnancy are conducive to achieve good pregnancy outcomes.
探讨左心室心肌致密化不全（LVNC）孕妇的临床特征及妊娠结局。回顾性分析2011年1月至2021年12月首都医科大学附属北京安贞医院7例LVNC孕妇的临床资料，包括年龄、首次出现症状时的孕周、LVNC病史、临床症状、纽约心脏病协会（NYHA）心功能分级、超声心动图、血脑钠肽（BNP）、治疗情况及母婴结局。5例在孕前确诊，其中3例有用药史；1例在孕月确诊；1例在孕36周确诊。妊娠早期或孕期NYHA心功能Ⅰ级4例，Ⅱ级3例。5例行超声心动图检查的孕妇中，妊娠早期或孕期左心室功能不全1例，轻度左心室功能障碍3例，左心室功能正常1例。5例孕妇至妊娠中晚期，NYHA分级Ⅳ级1例，Ⅲ级1例，Ⅱ-Ⅲ级2例，Ⅱ级1例；超声心动图显示左心室功能不全3例，左心室功能正常2例。4例孕妇在妊娠1524周出现心脏症状并接受药物治疗。4例孕妇孕期血BNP升高至2141197 ng/L，终止妊娠后为89~106 ng/L。4例有心律失常。终止妊娠指征：LVNC合并心力衰竭2例，LVNC合并心功能下降及先兆早产1例，足月妊娠合并LVNC 2例，LVNC合并重度肺动脉高压1例，左心室功能障碍1例。妊娠晚期剖宫产4例，妊娠中期剖宫产1例，产钳刮宫2例。2例足月婴儿、2例早产婴儿出生时无LVNC。孕前诊断为LVNC且左心室射血分数低的女性孕期更易出现心功能下降。进行妊娠风险评估并加强孕期高危因素的多学科团队管理有利于获得良好的妊娠结局。
