Rothlin M E, Egloff L, Fleisch M, Hirzel H O, Siebenmann R, Studer M, Tartini R
Herzzentrum Hirslanden, Zürich.
Schweiz Med Wochenschr. 1995 Feb 18;125(7):304-10.
Understanding of the mechanisms of cardiovascular and hemodynamic adaptation during pregnancy helps to prevent or manage complications in cardiac patients during gestation. Manifestations of coronary heart disease are exceptional during pregnancy and delivery. The same is true of disorders of the pericardium. Peripartal cardiomyopathy is a myocardial disorder of undetermined cause occurring shortly before, during or after delivery, which may take a fatal course. Hypertrophic obstructive or non-obstructive cardiomyopathy is compatible with gestation and delivery without serious complications in most cases. Rheumatic mitral stenosis was the most common cardiac disorder until the 1950s. Nowadays it is rarely seen in this country. Surgical and other interventional therapies have greatly changed the outlook in pregnant women with valvular heart disease. A highly controversial issue is heart valve replacement in young women and management of anticoagulation during pregnancy. Like any other drug therapy, anticoagulation during gestation requires careful weighing of the benefit for the mother against toxic and teratogenic effects for the fetus. In women with heart disease the management of pregnancy should start, if possible, before conception. Thorough counseling and proper planning of pregnancy and of therapeutic measures is essential in order to avoid or manage complications.
了解孕期心血管和血流动力学适应机制有助于预防或处理心脏病患者孕期的并发症。冠心病在妊娠和分娩期间的表现较为罕见。心包疾病也是如此。围产期心肌病是一种病因不明的心肌疾病，发生在分娩前、分娩期间或分娩后不久，可能会导致致命后果。肥厚性梗阻性或非梗阻性心肌病在大多数情况下与妊娠和分娩相容，不会出现严重并发症。直到20世纪50年代，风湿性二尖瓣狭窄一直是最常见的心脏疾病。如今在我国很少见。手术和其他介入治疗极大地改变了患有瓣膜性心脏病孕妇的预后。一个极具争议的问题是年轻女性的心脏瓣膜置换以及孕期抗凝管理。与任何其他药物治疗一样，孕期抗凝需要仔细权衡对母亲的益处与对胎儿的毒性和致畸作用。对于患有心脏病的女性，妊娠管理如果可能的话应在受孕前开始。全面的咨询以及对妊娠和治疗措施进行适当规划对于避免或处理并发症至关重要。
