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Abstract
Objective Congenital heart defects represent the most common major congenital anomalies. The objective of this review was to define the most common forms of congenital heart disease (CHD) in pregnancy, outline preconception counseling, discuss the associated morbidity and mortality of each lesion, and review current recommendations for management of CHD in pregnancy. Evidence Acquisition A MEDLINE search of "congenital heart disease in pregnancy" and specific conditions in pregnancy including "ventricular septal defect," "atrial septal defect," "left outflow obstruction," "right outflow obstruction," "tetralogy of Fallot," and "transposition of the great vessels" was performed. Results The evidence included in the review contains 18 retrospective studies, 8 meta-analyses or systematic reviews or expert opinions, 5 case reports including surgical case reports, 2 prospective studies, and 2 clinical texts. Conclusions Given advances in surgical and medical management, women with a history of congenital cardiac defects are more frequently reaching childbearing age and requiring obstetric care. Many women with CHD can have successful pregnancies, although there are a few conditions that confer significant maternal risk, and pregnancy may even be contraindicated. Appropriate care for women with CHD requires a knowledge of cardiac physiology in pregnancy, the common lesions of CHD, and coordinated care from cardiology and maternal-fetal medicine specialists.
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Pregnancy causes a transient decrease in systemic ventricular function in women with pre-existing cardiac disease. PROGRESS IN PEDIATRIC CARDIOLOGY 2017. [DOI: 10.1016/j.ppedcard.2016.11.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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Sayama S, Takeda N, Iriyama T, Inuzuka R, Maemura S, Fujita D, Yamauchi H, Nawata K, Bougaki M, Hyodo H, Shitara R, Nakayama T, Komatsu A, Nagamatsu T, Osuga Y, Fujii T. Peripartum type B aortic dissection in patients with Marfan syndrome who underwent aortic root replacement: a case series study. BJOG 2017; 125:487-493. [PMID: 28294527 DOI: 10.1111/1471-0528.14635] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/06/2017] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To investigate pregnancy outcomes, especially the risk of pregnancy-related aortic dissection (AD), in patients with Marfan syndrome (MFS) after prophylactic aortic root replacement (ARR). DESIGN Retrospective case series study. SETTING Tertiary perinatal care centre at a university hospital. POPULATION Pregnant women fulfilling the revised Ghent nosology (2010) criteria for MFS who were managed at our institute. METHODS The pregnancy outcomes of all patients with MFS managed at our institute between 1982 and September 2016 were reviewed retrospectively based on medical records. MAIN OUTCOME MEASURES Obstetrical management and complication including the incidence of AD throughout the peripartum period. RESULTS Among 22 patients (28 pregnancies) who had been managed as potential MFS or related disorders, 14 (17 pregnancies) fulfilled the revised Ghent nosology (2010) criteria for MFS and were enrolled in this study. Five patients (five pregnancies) had received ARR before conception: three (60%) developed type B aortic dissection [AD(B)] during the peripartum period, compared with only one of 10 patients (12 pregnancies) without ARR (P < 0.05, Chi-square test). CONCLUSIONS Our study results suggest that MFS patients after prophylactic ARR are still at high risk of AD(B) during the peripartum period. Careful pre-pregnancy counselling and multidisciplinary care throughout the peripartum period are essential for the management of MFS, even after surgical repair of an ascending aortic aneurysm. TWEETABLE ABSTRACT MFS patients after prophylactic ARR are still at high risk of type B aortic dissection during the peripartum period.
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Affiliation(s)
- S Sayama
- Department of Obstetrics and Gynecology, Faculty of Medicine, University of Tokyo, Tokyo, Japan
| | - N Takeda
- Department of Cardiovascular Medicine, Faculty of Medicine, University of Tokyo, Tokyo, Japan
| | - T Iriyama
- Department of Obstetrics and Gynecology, Faculty of Medicine, University of Tokyo, Tokyo, Japan
| | - R Inuzuka
- Department of Pediatrics, Faculty of Medicine, University of Tokyo, Tokyo, Japan
| | - S Maemura
- Department of Cardiovascular Medicine, Faculty of Medicine, University of Tokyo, Tokyo, Japan
| | - D Fujita
- Department of Cardiovascular Medicine, Faculty of Medicine, University of Tokyo, Tokyo, Japan
| | - H Yamauchi
- Department of Cardiovascular Surgery, Faculty of Medicine, University of Tokyo, Tokyo, Japan
| | - K Nawata
- Department of Cardiovascular Surgery, Faculty of Medicine, University of Tokyo, Tokyo, Japan
| | - M Bougaki
- Department of Anesthesiology and Pain Relief Center, Faculty of Medicine, University of Tokyo, Tokyo, Japan
| | - H Hyodo
- Department of Obstetrics and Gynecology, Tokyo Metropolitan Bokutoh Hospital, Tokyo, Japan
| | - R Shitara
- Department of Obstetrics and Gynecology, Faculty of Medicine, University of Tokyo, Tokyo, Japan
| | - T Nakayama
- Department of Obstetrics and Gynecology, Faculty of Medicine, University of Tokyo, Tokyo, Japan
| | - A Komatsu
- Department of Obstetrics and Gynecology, Faculty of Medicine, University of Tokyo, Tokyo, Japan
| | - T Nagamatsu
- Department of Obstetrics and Gynecology, Faculty of Medicine, University of Tokyo, Tokyo, Japan
| | - Y Osuga
- Department of Obstetrics and Gynecology, Faculty of Medicine, University of Tokyo, Tokyo, Japan
| | - T Fujii
- Department of Obstetrics and Gynecology, Faculty of Medicine, University of Tokyo, Tokyo, Japan
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Matura-Bedouhene M, Maatouk A, Moulin F, Welter E, Morel O, Perdriolle-Galet E. [Pregnancy in patients with a history of ischaemic heart disease - Case series and literature review]. J Gynecol Obstet Hum Reprod 2016; 45:407-413. [PMID: 26321610 DOI: 10.1016/j.jgyn.2015.06.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2015] [Revised: 06/08/2015] [Accepted: 06/18/2015] [Indexed: 06/04/2023]
Abstract
Heart diseases complicate 1 to 3% of pregnancies and are the leading cause of indirect maternal deaths. Prior ischaemic heart event in pregnant patients is increasing. Most knowledge is based on few reports and there are no French nor international recommendations about the specific management of these patients. The specificity of the management of these patients during pregnancy, delivery and post-partum depends on the severity of the prior cardiac event and its consequences. This will be illustrated by the report of four recent cases managed in our hospital. First patient had myocardial infarction with normal left ventricular ejection fraction (LVEF). Second patient had a Tako-Tsubo syndrome with LVEF 45%. Third patient had ischemic cardiopathy with LVEF 30%. Fourth patient had myocardial infarction with LVEF 20%. A multidisciplinary follow-up should be required, especially in patients with severe ventricular dysfunction. The risk of fetal growth restriction appears to be increased, suggesting that closer ultrasound monitoring is necessary.
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Affiliation(s)
- M Matura-Bedouhene
- Service de gynécologie-obstétrique, maternité régionale universitaire, 10, rue du Docteur-Heydenreich, 54000 Nancy, France.
| | - A Maatouk
- Service de gynécologie-obstétrique, CHR de Metz-Thionville, 1-3, rue du Friscaty, 57100 Thionville, France; Service de gynécologie-obstétrique, centre hospitalier Saint-Charles, 1, cours Raymond-Poincaré, 54520 Toul, France.
| | - F Moulin
- Institut Lorrain du cœur et des vaisseaux, 5, rue du Morvan, 54500 Vandœuvre-lès-Nancy, France.
| | - E Welter
- Service de gynécologie-obstétrique, CHR de Metz-Thionville, 1-3, rue du Friscaty, 57100 Thionville, France.
| | - O Morel
- Service de gynécologie-obstétrique, maternité régionale universitaire, 10, rue du Docteur-Heydenreich, 54000 Nancy, France; Inserm U947, laboratoire IADI, 54500 Vandœuvre-lès-Nancy, France.
| | - E Perdriolle-Galet
- Service de gynécologie-obstétrique, maternité régionale universitaire, 10, rue du Docteur-Heydenreich, 54000 Nancy, France; Inserm U947, laboratoire IADI, 54500 Vandœuvre-lès-Nancy, France.
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Vashisht A, Katakam N, Kausar S, Patel N, Stratton J. Postnatal diagnosis of maternal congenital heart disease: missed opportunities. BMJ Case Rep 2015; 2015:bcr-2015-209938. [PMID: 26370636 DOI: 10.1136/bcr-2015-209938] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
A 30-year-old primigravida with no known comorbidities presented to the emergency department at 29+6/40 gestation, with breathlessness. The initial diagnosis was pulmonary embolism, which was later revised following initial investigations and considered to be pre-eclampsia/HELLP (haemolysis, elevated liver enzymes, low platelets) syndrome. Following caesarean section and delivery of a live baby, the patient had episodes of cyanotic hypoxia and was admitted to intensive care. A provisional diagnosis of idiopathic pulmonary hypertension was performed. Decompensation led to transfer to a specialist intensive care unit for extracorporeal membrane oxygenation, where a diagnosis of patent ductus arteriosus and Eisenmenger's syndrome was made. Heart disease is the leading indirect cause of maternal death, and Eisenmenger's syndrome in pregnancy carries a 50-65% mortality. A literature review demonstrated that this is the only reported case of a postnatal diagnosis of Eisenmenger's syndrome. We considered missed opportunities to make an earlier diagnosis, so that patients and doctors will benefit from the lessons we learnt.
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Abstract
Heart disease complicates 1-2% of pregnancies, and in preparation for pregnancy, these women should receive comprehensive preconception counseling. Risks to the mother and potential risks to the offspring secondary to the type and severity of maternal cardiac disease, its inheritance pattern, required medical therapy, and palliative or corrective procedures that may be needed must be considered. Life expectancy and the ability to care for a child are somber issues that must be addressed when serious cardiac conditions exist. Pregnancy is still contraindicated in women with pulmonary hypertension, severe systemic ventricular dysfunction, dilated aortopathy, and severe left-sided obstructive lesions, but advances in medical and surgical management have resulted in an increasing number of patients with cardiac disorders who are interested in pursuing pregnancy. A multidisciplinary approach can best determine whether acceptable outcomes can be expected and what management strategies may improve the prognosis for women with heart disease and their offspring.
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Affiliation(s)
- Lynn L Simpson
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Columbia University Medical Center, 622 W 168th St, PH-16, New York, New York.
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Rendón ID, Soto M, Jaramillo M, Palacio AC, Restrepo JA. Tetralogía de Fallot y embarazo. REVISTA COLOMBIANA DE CARDIOLOGÍA 2014. [DOI: 10.1016/j.rccar.2014.04.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
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Management of the pregnant woman with Marfan syndrome complicated by ascending aorta dilation. Arch Gynecol Obstet 2014; 290:797-802. [DOI: 10.1007/s00404-014-3307-4] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2014] [Accepted: 05/28/2014] [Indexed: 10/25/2022]
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Robertson JE, Silversides CK, Ling Mah M, Kulikowski J, Maxwell C, Wald RM, Colman JM, Siu SC, Sermer M. A Contemporary Approach to the Obstetric Management of Women with Heart Disease. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2012; 34:812-819. [DOI: 10.1016/s1701-2163(16)35378-6] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
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Hinze A, Kutty S, Sayles H, Sandene EK, Meza J, Kugler JD. Reproductive and contraceptive counseling received by adult women with congenital heart disease: a risk-based analysis. CONGENIT HEART DIS 2012; 8:20-31. [PMID: 22691053 DOI: 10.1111/j.1747-0803.2012.00677.x] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
BACKGROUND/OBJECTIVE Our aim was to study the prevalence of counseling received by adult women with congenital heart disease to determine from whom they received such counseling and to describe their contraceptive and reproductive knowledge. METHODS/DESIGN Using a cross-sectional survey, information was collected from 83 women, ≥ 19 years of age with congenital heart disease from a group of 404 women followed in our adult congenital heart disease clinic. Women were stratified into combined hormonal contraceptive and pregnancy World Health Organization risk classes 1-4 based on cardiac lesion. RESULTS We hypothesized that >50% of women had not received both contraceptive and reproductive counseling that addressed their heart condition; indeed, 59% of women reported they had not received such counseling (P=.05). Women who had received heart-specific contraceptive counseling were in higher risk combined hormonal contraceptive World Health Organization classes (P=.02). Similarly, women who reported receiving counseling regarding risks of pregnancy were also in higher pregnancy World Health Organization risk classes (P=.002). Fifty-two of 77 women (63%) did not know if there was a contraindicated contraceptive method given their underlying heart condition; 16 of these 52 women (31%) were combined hormonal contraceptive class 3 or class 4. CONCLUSIONS This adult congenital heart disease survey study demonstrates an opportunity to improve individualized contraceptive and reproductive counseling with a goal toward minimizing each patient's risk of potentially avoidable adverse events. A stronger collaboration among health care professionals is needed to increase the prevalence of heart-specific counseling and to increase the quality of counseling these women are receiving.
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Affiliation(s)
- Alicia Hinze
- Joint Division of Pediatric Cardiology, University of Nebraska Medical Center College of Medicine, Omaha, NE 68114, USA
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JOSEFSSON ANN, KERNELL KRISTINA, NIELSEN NIELSERIK, BLADH MARIE, SYDSJÖ GUNILLA. Reproductive patterns and pregnancy outcomes in women with congenital heart disease - a Swedish population-based study. Acta Obstet Gynecol Scand 2011; 90:659-65. [DOI: 10.1111/j.1600-0412.2011.01100.x] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Manganaro L, Savelli S, Di Maurizio M, Perrone A, Francioso A, La Barbera L, Totaro P, Fierro F, Tomei A, Coratella F, Giancotti A, Ballesio L, Ventriglia F. Assessment of congenital heart disease (CHD): Is there a role for fetal magnetic resonance imaging (MRI)? Eur J Radiol 2009; 72:172-80. [DOI: 10.1016/j.ejrad.2008.06.016] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2008] [Revised: 05/28/2008] [Accepted: 06/06/2008] [Indexed: 11/27/2022]
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Manganaro L, Savelli S, Di Maurizio M, Francioso A, Fierro F, Tomei A, Coratella F, Ballesio L, Ventriglia F. Fetal MRI of the cardiovascular system: role of steady-state free precession sequences for the evaluation of normal and pathological appearances. Radiol Med 2009; 114:852-70. [PMID: 19568700 DOI: 10.1007/s11547-009-0419-1] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2008] [Accepted: 10/31/2008] [Indexed: 10/20/2022]
Abstract
PURPOSE This study aimed to evaluate the feasibility of fetal magnetic resonance imaging (MRI) with steady-state free precession (SSFP) sequences to visualise the normal and pathological appearances of the cardiovascular system. MATERIALS AND METHODS This is a prospective observational study of 83 pregnant women who underwent fetal cardiac MRI: 43 patients (cases) had echocardiographic suspicion of congenital heart disease; 40 patients (controls) did not. Fetal cardiac MRI consisted of a static phase with multiplanar SSFP sequences and a dynamic phase with real-time SSFP sequences. Two radiologists evaluated the diagnostic quality of the SSFP images in both the controls and cases, the MRI morphological and functional features in the controls and the MRI signs of congenital heart disease in the cases. RESULTS In both groups, SSFP sequences produced goodquality MR images and good visualisation of morphological features. Functional data appeared to be unavailable due to the current small temporal resolution and the technical impossibility of fetal cardiac triggering. MRI detected direct signs of congenital heart disease in 21 fetuses, indirect signs in six and both signs in 15. CONCLUSIONS SSFP sequences are effective in demonstrating the morphological features of the cardiovascular system, whereas dynamic SSFP cine-MRI sequences may provide adjunctive albeit suboptimal functional information.
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Affiliation(s)
- L Manganaro
- Dipartimento di Scienze Radiologiche, Sapienza Università degli Studi di Roma, Policlinico Umberto I, Viale del Policlinico 155, 00161 Rome, Italy
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Bibliography. Current world literature. Maternal-fetal medicine. Curr Opin Obstet Gynecol 2007; 19:196-201. [PMID: 17353689 DOI: 10.1097/gco.0b013e32812142e7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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