Mendelson M A
Northwestern Memorial Hospital, Chicago, IL.
Am J Card Imaging. 1995 Jan;9(1):44-52.
Advances in the diagnosis and treatment of congenital heart disease have improved survival for children born with complex congenital lesions. As the female patient enters adulthood, questions regarding the safety and feasibility of pregnancy arise. The hemodynamic changes of pregnancy may be well-tolerated by some patients and yet quite challenging to others. Complications may be anticipated based upon residual anatomic defects, type of surgery and sequelae of surgery. Specific congenital lesions are discussed with respect to hemodynamic changes of pregnancy in both the uncorrected and corrected states. Due to advances in diagnostic modalities, congenital heart disease may first be diagnosed in the adult patient during pregnancy. The risk of pregnancy in these women has not yet been completely defined as there is not a large experience regarding the more complicated lesions. Women should have a thorough preconception evaluation and be counselled about their potential risks. They should also be counselled that their fetus has an increased risk of congenital heart disease. Management during pregnancy, labor and delivery depends upon the specific cardiac problem. It must be individualized for the patient and formulated from a multidisciplinary approach involving obstetrics, cardiology and anesthesia.
先天性心脏病诊断和治疗方面的进展提高了患有复杂先天性病变儿童的生存率。随着女性患者步入成年期，关于怀孕的安全性和可行性的问题随之而来。怀孕时的血流动力学变化对一些患者来说可能可以很好地耐受，但对另一些患者而言却极具挑战性。可根据残余解剖缺陷、手术类型和手术后遗症来预测并发症。本文将针对未矫正和已矫正状态下怀孕时的血流动力学变化，讨论特定的先天性病变。由于诊断方式的进步，先天性心脏病可能在成年患者孕期首次被诊断出来。这些女性怀孕的风险尚未完全明确，因为对于更复杂病变的经验还不多。女性应进行全面的孕前评估，并接受关于其潜在风险的咨询。还应告知她们，其胎儿患先天性心脏病的风险增加。孕期、分娩期和产时的管理取决于具体的心脏问题。必须根据患者个体情况制定方案，并采用包括产科、心脏病学和麻醉学在内的多学科方法。
