生物瓣心脏瓣膜功能正常与功能障碍的女性妊娠结局。
Outcomes of Pregnancy in Women With Bioprosthetic Heart Valves With or Without Valve Dysfunction.
机构信息
Division of Cardiology, University of Toronto, Pregnancy and Heart Disease Program, Mount Sinai and Toronto General Hospitals, Toronto, Ontario, Canada; Department of Cardiology and Medical Intensive Care, Kepler University Hospital, Medical Faculty, Johannes Kepler University, Linz, Austria.
Division of Cardiology, University of British Columbia, St. Paul's Hospital, Vancouver, British Columbia, Canada.
出版信息
J Am Coll Cardiol. 2022 Nov 22;80(21):2014-2024. doi: 10.1016/j.jacc.2022.09.019.
BACKGROUND
Although pregnancy outcomes in women with normally functioning bioprosthetic valves (BPVs) are often good, structural valve dysfunction (SVD) may adversely affect pregnancy outcomes, but this has not been studied.
OBJECTIVES
The aim of this study was to examine outcomes in pregnant women with BPVs and the association with SVD.
METHODS
Pregnancy outcomes in women with BPVs were prospectively collected. Adverse maternal cardiac events (CEs) included cardiac death or arrest, sustained arrhythmia, heart failure, thromboembolism, and stroke. Adverse fetal events were also studied. Determinants of adverse events were examined using logistic regression.
RESULTS
Overall, 125 pregnancies in women with BPVs were included, 27% with left-sided and 73% with right-sided BPV. SVD was present in 27% of the pregnancies (44% with left-sided BPVs vs 21% with right-sided BPVs; P = 0.009). CEs occurred in 13% of pregnancies and were more frequent in women with SVD compared with those with normally functioning BPVs (26% vs 8%; P = 0.005). CEs were more common in women with left-sided BPVs with SVD vs normally functioning BPVs (47% vs 5%; P = 0.01) but not in women with right-sided BPVs (11% in those with SVD vs 8% in those without SVD; P = 0.67). Left-sided SVD (P = 0.007), maternal age >35 years (P = 0.001), and a composite variable of "high-risk" features (P = 0.006) were predictors of CEs. Fetal events occurred in 28% of pregnancies.
CONCLUSIONS
In this cohort of young women with BPVs, SVD was present in 27% at the first antenatal visit and negatively affected pregnancy outcomes. In particular, SVD of left-sided BPVs was associated with high rates of adverse outcomes.
背景
尽管正常功能的生物瓣（BPV）女性的妊娠结局通常良好，但结构性瓣膜功能障碍（SVD）可能会对妊娠结局产生不利影响，但这尚未得到研究。
目的
本研究旨在检查 BPV 孕妇的妊娠结局，并研究其与 SVD 的关系。
方法
前瞻性收集 BPV 孕妇的妊娠结局。不良母体心脏事件（CEs）包括心脏骤停或骤停、持续性心律失常、心力衰竭、血栓栓塞和中风。还研究了不良胎儿事件。使用逻辑回归检查不良事件的决定因素。
结果
总体而言，共有 125 例 BPV 孕妇的 125 次妊娠，其中 27%为左侧 BPV，73%为右侧 BPV。27%的妊娠存在 SVD（左 BPV 中 44%，右 BPV 中 21%；P=0.009）。13%的妊娠发生 CEs，SVD 孕妇比正常功能 BPV 孕妇更常见（26%比 8%；P=0.005）。左 BPV 合并 SVD 的孕妇 CEs 更为常见（47%比 5%；P=0.01），而右 BPV 患者则不然（SVD 患者中 11%，无 SVD 患者中 8%；P=0.67）。左 SVD（P=0.007）、产妇年龄>35 岁（P=0.001）和“高危”特征的综合变量（P=0.006）是 CEs 的预测因素。28%的妊娠发生胎儿事件。
结论
在本队列中，首次产前检查时 27%的年轻 BPV 女性存在 SVD，这对妊娠结局产生了不利影响。特别是，左 BPV 的 SVD 与不良结局发生率较高相关。
Zotero 插件