Hatano Y
Fortschr Med. 1977 Mar 17;95(11):685-9.
The early diagnosis of heart disease during or better before pregnancy is one of the most important problems, as cardiac diseases are the most common cause for maternal deaths throughout the world. The knowledge of hemodynamic alterations in circulatory and respiratory physiology during pregnancy complicated by heart disease is a prerequisite for their management. The following indications for therapeutic abortion of pregnancy complicated by heart disease can be concluded according to our own observations: 1. history of significant heart failure (more than grade IV according to the classification of the New York Heart Association), frequent attacks of angina pectoris and longstanding cyanosis: 2. in spite of the most careful heart treatment with digitalis, diuretics and salftree diet cardiac-thorax-rate of more than 55% in congenital heart disease, cardiac-thorax-rate of more than 60% in acquired heart disease, significant signs of heart failure, namely more severe than grade III, tachycardic atrial fibrillation, pulse deficit of more than 30/min, active inflammatory processes of the heart (rheumatic fever, subacute bacterial endocarditis, Takayasu's disease); 3. especially severe metabolic disorders, i.e. diabetes mellitus, malignant hypertension, kidney diseases; 4. primiparae of an age of more than 35 years with any heart disease. Commissurotomy can be accomplished during pregnancy if it is too late for therapeutic abortion. Pregnancy in case of artificial valves is not recommended in general because of impending hemorrhagic diathesis.
在孕期或最好在怀孕前早期诊断心脏病是最重要的问题之一，因为心脏病是全世界孕产妇死亡的最常见原因。了解妊娠合并心脏病时循环和呼吸生理学中的血流动力学改变是对其进行管理的前提条件。根据我们自己的观察结果，可以得出以下妊娠合并心脏病治疗性流产的指征：1. 有严重心力衰竭病史（根据纽约心脏病协会分类超过IV级）、频繁心绞痛发作和长期发绀；2. 尽管用洋地黄、利尿剂和低盐饮食进行了最精心的心脏治疗，但先天性心脏病时心脏胸比率超过55%，后天性心脏病时心脏胸比率超过60%，有明显心力衰竭体征，即比III级更严重、快速性心房颤动、脉率差值超过30次/分钟、心脏有活动性炎症过程（风湿热、亚急性细菌性心内膜炎、高安氏病）；3. 尤其严重的代谢紊乱，即糖尿病、恶性高血压、肾脏疾病；4. 年龄超过35岁的初产妇合并任何心脏病。如果治疗性流产为时已晚，可在孕期进行心脏瓣膜切开术。一般不建议人工瓣膜患者怀孕，因为有出血素质的风险。
