SummaryBackground: Previously, the high maternal mortality in cardiac patients who became pregnant prompted the assertion: Women with an abnormal heart should not become pregnant. This long-standing notion needs to be revised today.Hypothesis: The study was undertaken to ascertain the experience with a large series of pregnant women with cardiac disease cared for in the same referral center.Methods: From 1989 to 1999, 1,000 pregnant women with heart disease were followed by the same clinical and obstetric team. The cardiac diseases included rheumatic heart disease (55.7%), congenital heart disease (19.1%), Chagas' disease (8.5%), cardiac arrhythmias (5.1%), cardiomyopathies (4.3%), and others (7.3%).Results: Of the pregnant women studied, 765 (76.5%) experienced no cardiovascular events during the study; 235 (23.5%) patients had the following cardiovascular complications: congestive heart failure (12.3%), cardiac arrhythmias (6%), thromboembolism (1.9%), angina (1.4%), hypoxemia (0.7%), infective endocarditis (0.5%), and other complications (0.7%). Clinical treatment allowed adequate management in 161 (68.8%) patients; however, 46 (19.6%) patients underwent interventional procedures because of refractory complications. The general maternal mortality rate was 2.7%. Of the 915 (91.5%) infants who were discharged, 119 (13%) were premature.

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Interruption of pregnancy is usually recommended for pregnant women with Eisenmenger's syndrome. We studied 13 pregnancies in 12 women with this syndrome, who decided to carry on with their pregnancy despite recommendation for therapeutic abortion. The mean age was 27 years. Five patients had ventricular septal defect; two, persistent ductus arteriosus; one, a combination of both; two, atrial septal defect; one, atrioventricular septal defect and one patient a combination of ventricular and atrial septal defects. Mean systolic and diastolic arterial pulmonary pressures were 112.7 and 61.7, mmHg, respectively. There were three spontaneous abortions, one premature labour at 23 weeks of gestation and two maternal deaths during the 23 and 27 weeks of gestation. Seven patients who reached the end of the second trimester were hospitalized until delivery and received heparin (20,000 to 40,000 units per day) and oxygen therapy. Caesarean section was performed in all patients as a result of worsening maternal or fetal clinical condition during the third trimester of gestation. all the mothers were discharged from hospital but one of them died on the 30th day post-partum. Five of the eight infants were premature, three were small babies for gestational age and all were discharged from hospital with the exception of one who died 48 h after birth. In conclusion, although pregnancy should be discouraged in women with Eisenmenger's syndrome, it can be successful. In this study, prolonged bed rest, the use of heparin and oxygen therapy presumably positively influenced maternal and infant outcomes.

Nota: estas Atualizações se prestam a informar e não a substituir o julgamento clínico do médico que, em última análise, deve determinar o tratamento apropriado para seus pacientes.

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Objective -To assess pregnancy outcome in women with peripartum cardiomyopathy and to compare it with idiopathic cardiomyopathy. Peripartum cardiomyopathy is a rare disease of unknown cause that affects women of reproductive age. Its incidence is related to the peripartum period. Hypotheses of its cause are focused on the physiologic relationship between pregnancy and the postpartum period and infective genetic disorders and hormonal and metabolic changes [1][2][3] . The criteria for diagnosis of peripartum cardiomyopathy include heart failure in the last month of pregnancy or within the first 5 postpartum months, in the absence of a determinable cause of cardiac failure or the absence of demonstrable preexisting heart disease 4 , and systolic dysfunction confirmed by a lower ejection fraction (EF) or the left ventricular fractional shortening, or both of these, shown by echocardiographic measurement 5 . Studies [6][7][8] about the natural cause of peripartum cardiomyopathy estimate that more than half of these patients experience a regression in ventricular dysfunction, while about 25% evolve to death within 3 months due to heart failure, arrhythmias, or thromboembolism and the remaining patients develop dilated cardiomyopathy. Methods -No consensus, therefore, exists regarding recommendations for future pregnancies in women who have peripartum cardiomyopathy. The persistence of ventricular dysfunction is associated with a high risk of complications and maternal death. On the other hand, the recovery of ventricular function does not assure a good prognosis of the next pregnancy, in addition to the hypotheses about the recurrence of the disease, decreased EF, and heart failure in the peripartum period 9,10 . We undertook a study to evaluate the clinical and obstetric evolvement of pregnancy in women with a previous diagnosis of peripartum cardiomyopathy, to evaluate the factors associated with its prognosis, and to compare it with the evolvement of patients with idiopathic dilated cardiomyopathy. MethodsFrom 1990 to 1998, 26 pregnant women were followed. All had dilated cardiomyopathy discovered during routine

The benefits of surgical treatment for patients with congenital heart disease in relation to pregnancy are still controversial. We studied 48 pregnant women (mean age = 25 years) with surgically-corrected congenital heart diseases (Group 1). This included 15 cyanotic diseases: Fallot's tetralogy (11 cases); Ebstein's anomaly (2 cases); transposition of the great arteries (1 case); and double outlet of the right ventricle (1 case). We compared them to 52 pregnant women (mean age = 26 years) with untreated congenital heart diseases, which included 11 cases of Eisenmenger's syndrome (Group 2). Group 2 showed a higher incidence of maternal death (12 vs. 0 percent; p=0.01), perinatal mortality (15 vs. 0 percent; p=0.01) and prematurity (32 vs. 7 percent; p=0.01). Spontaneous abortion (4 vs. 10 percent), Caesarean deliveries (48 vs. 66 percent) or growth retardation (13 vs. 28 percent) did not present any significant differences between these groups. Surgical treatment in patients with heart diseases is associated with a better maternal and fetal prognosis. Therefore, surgery must be considered when counseling patients with congenital heart diseases.

Note: These statements are for information purposes and should not replace the clinical judgment of a physician, who must ultimately determine the appropriate treatment for each patient.