Hemodynamic adaptation to pregnancy in women with structural heart disease

INTERNATIONAL JOURNAL OF CARDIOLOGY

卷:168

Article

Cornette, J.¹  Ruys, T. P. E.²  Rossi, A.³  Rizopoulos, D.⁴  Takkenberg, J. J. M.⁵  Karamermer, Y.^2,3  Opic, P.²  Van den Bosch, A. E.²  Geleijnse, M. L.²  Duvekot, J. J.¹  Steegers, E. A. P.¹  Roos-Hesselink, J. W.² 

[1] Univ Med Ctr, Erasmus MC, Dept Obstet & Gynaecol, Div Obstet & Prenatal Med, NL-3015 GJ Rotterdam, Netherlands

[2] Univ Med Ctr, Erasmus MC, Dept Cardiol, NL-3015 GJ Rotterdam, Netherlands

[3] Univ Med Ctr, Erasmus MC, Dept Radiol, NL-3015 GJ Rotterdam, Netherlands

[4] Univ Med Ctr, Erasmus MC, Dept Biostat, NL-3015 GJ Rotterdam, Netherlands

[5] Univ Med Ctr, Erasmus MC, Dept Thorac Surg, NL-3015 GJ Rotterdam, Netherlands

关键词: Congenital;    Heart;    Pregnancy;    Hemodynamic;   

DOI  :  10.1016/j.ijcard.2012.10.005

来源: Elsevier

【 摘 要 】

Background: Many women with structural heart disease reach reproductive age and contemplate motherhood. Pregnancy induces and requires major hemodynamic changes. Pregnant women with structural heart disease may have a reduced cardiac reserve. There are no longitudinal data on cardiovascular adaptation throughout pregnancy in women with structural heart disease. Methods: Thirty-five women with structural heart disease were included in a prospective observational trial. Maternal hemodynamics were assessed before conception, during pregnancy and 6 months postpartum by transthoracic echocardiography. Uteroplacental perfusion was analyzed by obstetric Dopplers. Longitudinal evolution over time was analyzed as well as the long term influence of pregnancy on cardiac function. Results: Cardiac output (CO), stroke volume (SV), left ventricular mass (LV mass) and E/E' ratio significantly increased and ejection fraction (EF) and fractional shortening (FS) decreased during pregnancy. There was a statistically significant difference in EF, FS and E/E' ratio before and after pregnancy. Conclusions: The characteristic pattern of hemodynamic adaptation to pregnancy is attenuated in women with structural heart disease. The pregnancy related volume load induces progression of diastolic dysfunction. Our data suggest a persistent reduction in systolic and diastolic cardiac functions after pregnancy in women with structural heart disease. (c) 2012 Elsevier Ireland Ltd. All rights reserved.

【 授权许可】

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