Outcome of pregnancy in patients with structural or ischaemic heart disease: results of a registry of the European Society of Cardiology

Roos‐Hesselink, Jolien W.; Ruys, Titia P.E.; Stein, Joerg I.; Thilén, Ulf; Webb, Gary D.; Niwa, Koichiro; Kaemmerer, Harald; Baumgartner, Helmut; Budts, Werner; Maggioni, Aldo P.; Tavazzi, Luigi; Taha, Nasser; Johnson, Mark R.; Hall, Roger

doi:10.1093/eurheartj/ehs270

Cited by 399 publications

(317 citation statements)

References 21 publications

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“…In women with heart disease, maternal mortality is reportedly 1%, which is much higher than the average of 0.07% [2]. Therefore, understanding the management of pregnancy in patients with heart disease is important.…”

Section: Discussionmentioning

confidence: 99%

“…Knowledge of the risks of pregnancy with heart disease is important because maternal mortality is reportedly much higher than the average mortality in women with heart disease [1] [2]. Most pregnant patients with heart disease have congenital heart disease (66%), followed by valvular heart disease (26%), cardiomyopathy (7%), and ischemic heart disease (2%) [2].…”

Section: Introductionmentioning

confidence: 99%

“…Most pregnant patients with heart disease have congenital heart disease (66%), followed by valvular heart disease (26%), cardiomyopathy (7%), and ischemic heart disease (2%) [2]. Peripartum cardiomyopathy (PPCM) is a kind of cardiomyopathy occurring during the peripartum period.…”

Section: Introductionmentioning

confidence: 99%

“…Peripartum cardiomyopathy (PPCM) is a kind of cardiomyopathy occurring during the peripartum period. PPCM rarely occurs during pregnancy, but a pregnancy with a high risk of adverse outcomes for both the mother and baby is difficult to manage [2].…”

Section: Introductionmentioning

confidence: 99%

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A Pregnant Patient with Aortic Regurgitation and Symptoms of Acute Heart Failure Caused by Peripartum Cardiomyopathy: A Case Report

Mori¹,

Shimizu²,

Takahashi³

et al. 2017

OJAnes

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Introduction: Knowledge of the risks of pregnancy with heart disease is important because the maternal mortality is much higher than the average. Peripartum cardiomyopathy (PPCM) is rare but it is one of major causes of maternal death. We experienced a pregnant patient with severe aortic regurgitation (AR) presented symptoms of acute heart failure. Her heart failure was not better after an emergency cesarean section and aortic valve replacement (AVR) therefore we think that PPCM caused her heart failure. Case presentation: A 35-year-old woman diagnosed as having severe AR became pregnant. No changes in the AR were apparent during pregnancy. However, the patient developed symptoms of acute heart failure at 37 weeks of gestation, and an emergency cesarean section was performed under general anesthesia. Her hemodynamic status worsened after the cesarean section, and AVR was performed. She was supported with percutaneous cardiopulmonary support (PCPS) after the operation. As recovery seemed to take longer than usual, we decided to implant a ventricular assist device (VAD). Her condition improved after VAD placement, but then she died from a cerebral infarction. In this case, the heart failure was an acute-onset even though AR was stable before and after the pregnancy, and the heart failure did not improve after AVR. Therefore, we concluded that PPCM, rather than AR caused her heart failure. Conclusions: We encountered a case of a pregnant patient with severe AR who presented with symptoms of acute heart failure caused by PPCM. The effect of AR to her heart failure could not be easily denied. This delayed the diagnosis of PPCM, which in turn delayed our decision to use a VAD. Therefore, PPCM should be considered when pregnant patients with heart disease present symptoms of heart failure.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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A Pregnant Patient with Aortic Regurgitation and Symptoms of Acute Heart Failure Caused by Peripartum Cardiomyopathy: A Case Report

Mori¹,

Shimizu²,

Takahashi³

et al. 2017

OJAnes

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“…(1) The occurrence of cardiovascular diseases in pregnancy ranges between 0.2% and 4% in Western countries (2) and the complications are related to the occurrence of thromboembolic events, heart failure, arrhythmias, among others. (3) In Brazil, the incidence of cardiopathy during pregnancy surpasses the international statistics, corresponding to 4.2%. (4) This percentage is attributed to the high incidence of rheumatic disease affecting women of reproductive age and represents 80% of cardiac diseases in pregnancy in developing countries.…”

Section: Introductionmentioning

confidence: 99%

Qualidade de vida de cardiopatas durante a gestação e após o parto

2016

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Objective: Analyze the changes in the quality of life of cardiac patients during pregnancy and after birth and study the correlations between the sociodemographic and clinical characteristics and quality of life measures during the postpartum period. Methods: This prospective study included 33 pregnant women selected through non-probabilistic sampling. The research instrument was the SF-36 questionnaire. To compare the mean domain scores of the SF-36, Student's t-test was used, as well as Spearman's coefficient for possible correlations. Results: In comparison with the pregnancy, the assessed quality of life improved after birth, except in the domains general health status and vitality. The variable pregnancy planning indicated a positive correlation with the mental health domain and a negative correlation with emotional aspects in the postpartum period. Conclusion: After birth, the quality of life improved. Not planning the pregnancy contributed to improve the mental health, but aggravated the emotional aspects in the postpartum period. ResumoObjetivo: Analisar as mudanças na qualidade de vida em pacientes cardiopatas durante a gestação e após o parto, e estudar as correlações das características sociodemográficas e clínicas com medidas de qualidade de vida no puerpério. Métodos: Estudo prospectivo que incluiu 33 gestantes selecionadas por amostra não probabilística. O instrumento de pesquisa foi o questionário SF-36. Para a comparação das médias dos escores dos domínios do SF-36 foi utilizado o test t de Student e o coeficiente de Spearman para possíveis correlações. Resultados: Comparada à gestação, houve melhora na avaliação de qualidade de vida após o parto, exceto nos domínios estado geral de saúde e vitalidade. A variável planejamento da gestação indicou correlação positiva com o domínio saúde mental e negativa com aspectos emocionais no puerpério. Conclusão: Após o parto houve melhora na qualidade de vida. Não planejar a gestação contribuiu melhorou a saúde mental, mas agravou os aspectos emocionais no puerpério.

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Effectiveness of Implanted Cardiac Rhythm Recorders With Electrocardiographic Monitoring for Detecting Arrhythmias in Pregnant Women With Symptomatic Arrhythmia and/or Structural Heart Disease

et al. 2020

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IMPORTANCEArrhythmias are an important cause of maternal morbidity and mortality but remain difficult to diagnose. OBJECTIVE To compare implantable loop recorder (ILR) plus 24-hour Holter electrocardiographic (ECG) monitoring with standard 24-hour Holter ECG monitoring alone in terms of acceptability, ability to identify significant arrythmias, and effect on management and pregnancy outcome in women who were symptomatic or at high risk of arrythmia because of underlying structural heart disease. DESIGN, SETTING, AND PARTICIPANTS This single-center, prospective randomized clinical trial recruited 40 consecutive patients from the Cardiac Disease and Maternity Clinic at Groote Schuur Hospital in Cape Town, South Africa. Pregnant patients with symptoms of arrhythmia and/or structural heart disease at risk of arrhythmia were included. INTERVENTION Patients were randomized to standard care (SC; 24-hour Holter ECG monitoring [n = 20]) or standard care plus ILR (SC-ILR; 24-hour Holter ECG monitoring plus ILR [n = 20]). Only 17 consented to ILR insertion, and the 3 who declined ILR were allocated to the SC group. MAIN OUTCOMES AND MEASURES Arrhythmias considered included atrial fibrillation, atrial flutter, premature ventricular complexes, supraventricular tachycardia, ventricular tachycardia, or ventricular fibrillation.RESULTS Among the 40 women in this trial, the mean (SD) age was 28.4 (5.5) years. Holter monitoring detected arrhythmias in 3 of 23 patients (13%) in the SC group and 4 of 17 patients (24%) in the SC-ILR group compared with 9 of 17 patients (53%) patients who had arrhythmias detected by ILR. Seven patients (4 with supraventricular tachycardia, 1 with premature ventricular complexes, and 2 with paroxysmal atrial fibrillation recorded by ILR) did not have arrhythmias detected by 24-hour Holter monitoring. Three of these 7 patients (43%) had a change in management as a result of their ILR recordings. There were no maternal deaths. However, the SC group had a significantly lower mean (SD) gestational stage at delivery (35 [5] weeks vs 38 [2], P = .04). CONCLUSIONS AND RELEVANCEThe ILR was better than 24-hour Holter monitoring in detecting arrhythmias, which led to a change in management for a significant proportion of patients. Our findings suggest that ILR may be beneficial for pregnant women at risk of arrhythmia.

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Outcome of pregnancy in patients with structural or ischaemic heart disease: results of a registry of the European Society of Cardiology

Abstract: The vast majority of patients can go safely through pregnancy and delivery as long as adequate pre-pregnancy evaluation and specialized high-quality care during pregnancy and delivery are available. Pregnancy outcomes were markedly worse in patients with CMP and in developing countries.

Cited by 399 publications

References 21 publications

A Pregnant Patient with Aortic Regurgitation and Symptoms of Acute Heart Failure Caused by Peripartum Cardiomyopathy: A Case Report

A Pregnant Patient with Aortic Regurgitation and Symptoms of Acute Heart Failure Caused by Peripartum Cardiomyopathy: A Case Report

Qualidade de vida de cardiopatas durante a gestação e após o parto

Effectiveness of Implanted Cardiac Rhythm Recorders With Electrocardiographic Monitoring for Detecting Arrhythmias in Pregnant Women With Symptomatic Arrhythmia and/or Structural Heart Disease

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