Panebianco Mario, Perrone Marco Alfonso, Gagliardi Maria Giulia, Galletti Lorenzo, Bassareo Pier Paolo
Department of Cardiac Surgery, Cardiology, Heart and Lung Transplantation Bambino Gesu' Children's Hospital, IRCCS, 71013 Rome, Italy.
Division of Cardiology and CardioLab, Department of Clinical Sciences and Translational Medicine, University of Rome Tor Vergata, 00133 Rome, Italy.
Healthcare (Basel). 2023 May 30;11(11):1592. doi: 10.3390/healthcare11111592.
Although not completely devoid of risk, pregnancy can be managed in virtually all patients affected by even the most complex forms of congenital heart disease. It is not however advisable in patients with any form of pulmonary arterial hypertension. Pregnancy is even manageable in patients with univentricular heart converted to Fontan circulation. A personalised risk stratification should be performed, and patients affected by advanced NYHA functional class appropriately warned of the potential risks. In this setting, metabolomics might represent a novel tool for use in conducting personalised risk stratification. All pregnancies, particularly those at higher risk, should be managed in a tertiary care centre capable of providing the necessary assistance to both the mother and infant. With a few rare exceptions, vaginal delivery is to be preferred over caesarean section due to the lower degree of maternal and foetal complications. The desire for motherhood, at times extreme in women with congenital heart disease, may often be accomplished, thus providing a ray of hope in the lives of these patients.
尽管并非完全没有风险，但即使是患有最复杂形式先天性心脏病的几乎所有患者，怀孕也可以得到妥善管理。然而，对于任何形式的肺动脉高压患者，怀孕并不适宜。对于已转换为Fontan循环的单心室心脏患者，怀孕也是可以控制的。应进行个性化的风险分层，并适当地警告纽约心脏协会（NYHA）功能分级较高的患者潜在风险。在这种情况下，代谢组学可能是用于进行个性化风险分层的一种新工具。所有怀孕，尤其是那些风险较高的怀孕，都应在能够为母婴提供必要帮助的三级护理中心进行管理。除了少数罕见的例外情况，由于母婴并发症程度较低，阴道分娩优于剖宫产。先天性心脏病女性有时对为人母的渴望极为强烈，这种愿望往往可以实现，从而为这些患者的生活带来一线希望。
