Jackson G M, Dildy G A, Varner M W, Clark S L
Department of Obstetrics and Gynecology, University of Utah School of Medicine, Salt Lake City.
Obstet Gynecol. 1993 Oct;82(4 Pt 2 Suppl):680-2.
Because of advances in surgical repair, an increasing number of women born with structural cardiac disease now live to reproductive age. Patients treated successfully in childhood are followed for varying periods of time, then may be lost to follow-up or told that no follow-up is necessary because their condition is stable. However, the hemodynamic changes that accompany pregnancy may result in cardiovascular decompensation, even after years of apparently good health.
We have recently cared for two women who had undergone repair of congenital heart disease in childhood. Although they thought that their repair was complete and they had been asymptomatic until the pregnancy, both presented with symptoms and signs of severe pulmonary hypertension, subsequently confirmed on cardiac catheterization. One patient elected to terminate her pregnancy, and the other died in the immediate puerperium.
Despite normal physical function and an absence of abnormal physical findings, a thorough cardiac evaluation including echocardiography should be considered for pregnant patients with a history of repaired congenital heart disease, especially if the original defect is known to lead to pulmonary hypertension.
由于外科修复技术的进步，越来越多患有结构性心脏病的女性活到了生育年龄。儿童期接受成功治疗的患者会被随访不同的时间段，然后可能会失去随访，或者被告知由于病情稳定无需随访。然而，即使经过多年看似良好的健康状况，妊娠伴随的血流动力学变化仍可能导致心血管失代偿。
我们最近诊治了两名儿童期接受过先天性心脏病修复术的女性。尽管她们认为修复是彻底的，并且在妊娠前一直无症状，但两人均出现了严重肺动脉高压的症状和体征，随后经心导管检查得以证实。一名患者选择终止妊娠，另一名患者在产褥期即刻死亡。
对于有先天性心脏病修复史的孕妇，尽管其身体功能正常且无异常体征，仍应考虑进行包括超声心动图在内的全面心脏评估，尤其是当已知原始缺陷会导致肺动脉高压时。
