Cardiac Surgery and Obstetric Strategy for Thromboembolic Complications in Pregnant Women and Parturients

Сіромаха, С. О.; Rusnak, A. O.; Davydova, Iu.V.; Mazur, O. A.; Kuchkova, N. P.; Lazoryshynets, V. V.

doi:10.30702/ujcvs/20.3803/010069-074

Cited by 2 publications

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“…Компресійна ультразвукова допплерографія -це неінвазивний тест з чутливістю 97 % та специфічністю 94 % для діагностики симптоматичного проксимального тромбозу глибоких вен, що застосовується під час діагностики вірогідності ТЕЛА, як одної з причин ЛГ [3,13].…”

Section: український журнал серцево-судинної хірургії 2020 4 (41)unclassified

Pulmonary Hypertension and Pregnancy

Сіромаха¹,

Davydova²

2020

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Pregnancy in patients with any type of pulmonary hypertension (PH) is associated with significant morbidity and mortality. That is why pulmonary artery hypertension (PAH) is a contraindication to pregnancy and belongs to class IV maternal cardiovascular risks. Maternal mortality rates for pulmonary (especially arterial) hypertension remain high even in the era of specific therapy, in particular, it reaches 12-30% in patients with PAH, 36% in Eisenmenger syndrome and up to 56% in secondary PH. Perinatal effects in such patients are also unfavorable, with high rates of fetal loss, premature birth and miscarriage. Multidisciplinary team of specialists of the National Amosov Institute of Cardiovascular Surgery and Institute of Pediatrics, Obstetrics and Gynecology named after acad. O. M. Lukianova has been providing medical support to such women for 7 years, using modern recommendations and wide experience. Overall, 39 pregnant and parturient women with PH were admitted to the clinic of the National Amosov Institute of Cardiovascular Surgery in the period from December 2013 to October 2020. Patients with PH were assigned to group II (n=24), and those with PAH (8 women) and acute PH (7 women) were assigned to group I. A total of 20 cardiac surgeries were performed. Patients with acute PH (n=6) underwent operations with cardiopulmonary bypass, those with critical mitral valve stenosis had “closed” off-pump surgery, and also there was one case of ECMO system implantation in patient with dilated cardiomyopathy (CMP). Endovascular operations (n=4) involved occluder implantation to patent ductus arteriosus (PDA), implantation of a cardioverter-defibrillator, cardiac resynchronization therapy with pacemaker (CRT-P) and cava-filter insertion. Early (n=1) and late (n=1) maternal mortality rates were 2.6% each. Perinatal loss (n=5) was 12.8%. The main goal at the preconception stage in patients with PH is to eliminate causative factors, and, if it is impossible (idiopathic, familial PAH, Eisenmenger syndrome, etc.), to avoid pregnancy. Patients who become pregnant should be informed of the high risk of pregnancy and discuss abortion, regardless of the WHO FC or other predictive markers. At prolongation of pregnancy careful clinical monitoring, by pregnancy heart team members is strongly recommended. Multidisciplinary support of pregnant women with PH is the cornerstone of a successful treatment strategy for such patients. The professional association of obstetric risk specialists, cardiologists, interventionists, neonatologists, and cardiac surgeons significantly increases the chances of a PH patient for safe delivery and giving birth to a healthy baby.

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Section: український журнал серцево-судинної хірургії 2020 4 (41)unclassified

Pulmonary Hypertension and Pregnancy

Сіромаха¹,

Davydova²

2020

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“…Однак при деяких видах ВВС (аортальний стеноз, стеноз легеневої артерії, коарктація аорти, транспозиція магістральних судин) частота гіпертонічних розладів виявляється значно вищою -від 13 до 16 % завершених вагітностей. Тромбоемболічні події зазвичай спостерігаються 1 раз на 1000-2000 вагітностей [9,10], при значному збільшенні частоти таких ускладнень у жінок із ВВС (1 : 50) [7]. Значною загрозою при вагітності є розвиток гострого розшарування аорти у пацієнток з аортопатіями (набутими чи вродженими), а також за наявності так званих сімейних захворювань грудної аорти (СЗГА) [11].…”

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Maternal and Perinatal Risk Stratification in Cardiovascular Pathology. A Modern View on the Problem

Сіромаха¹,

Davydova²,

Limanska³

et al. 2020

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Objective: to increase the safety of a patients with cardiovascular pathology during the implementation of their reproductive function, by presenting a modern strategy of medical support for such women based on the assessment of the maternal and perinatal risks.Cardiac pathology is the leading cause of morbidity in pregnant women and an indirect cause of maternal mortality. In recent decades, the focus on the problem of safety of pregnant women with the pathology has been steadily increasing. Stratification of patients by cardiovascular risk (CVR) consists of assessing the functional capacity of the patient, cardiac medications needs, history of previous cardiac events, diagnosis of structural, anatomical, and physiological changes and parameters of heart remodeling, and, if necessary, genetic counseling. An important point is to inform the patient about the potential risks and make a consensus decision with her about the possibility of safe implementation of her reproductive function. The authors of the paper analyze the CVR assessment scales used in leading medical practices and the national health care system as well, discuss current clinical guidelines for risk stratification and registered strategies for pregnancy and delivery management depending on the class of CVR in such patients. This paper presents the basic principles of medical support for women of reproductive age with pathology of the heart and great vessels in the form of an algorithm developed by the National pregnancy heart team. Determination of the degree of risk allows to prepare a woman with cardiovascular pathology for the pregnancy and delivery (medical correction or preventive cardiac surgery). Research on the identification and categorization of maternal and perinatal CVR factors and stratification of pregnant women by risk classes are extremely relevant and continue in the framework of the international study ROPAC (Registry Of Pregnancy And Cardiac disease).Ukrainian multidisciplinary team (on the base of two academic State Institutions – “National Amosov Institute of Cardiovascular Surgery” and “Institute of Pediatrics, Obstetrics and Gynecology named after acad. O.M. Lukianova”) takes an active part in this international collaboration.

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Cardiac Surgery and Obstetric Strategy for Thromboembolic Complications in Pregnant Women and Parturients

Cited by 2 publications

References 8 publications

Pulmonary Hypertension and Pregnancy

Pulmonary Hypertension and Pregnancy

Maternal and Perinatal Risk Stratification in Cardiovascular Pathology. A Modern View on the Problem

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