Pregnancy outcomes in patients with pulmonary arterial hypertension associated with congenital heart disease

Ladouceur, Magalie; Benoit, Louise; Radojevic, Jelena; Basquin, Adeline; Dauphin, Claire; Hascoët, Sébastien; Moceri, Pamela; Bredy, Charlène; Iserin, Laurence; Gouton, Marielle; Nizard, J.

doi:10.1136/heartjnl-2016-310003

Cited by 78 publications

(84 citation statements)

References 25 publications

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“…[8][9][10][11][12] Two deaths happened within 1 week of delivery in this study, highlighting the crucial importance of monitoring and management with involvement of MDT in the postpartum period. [8][9][10][11][12] Two deaths happened within 1 week of delivery in this study, highlighting the crucial importance of monitoring and management with involvement of MDT in the postpartum period.…”

Section: Discussionmentioning

confidence: 99%

“…4 Women with PH tolerate haemodynamic changes of pregnancy poorly, which results in deterioration leading to maternal/fetal demise. [5][6][7][8][9][10][11][12] Advances in medical care have led to an increase in the life expectancy of patients with PH. [5][6][7] There is an increased risk of preterm birth and fetal growth restriction, in addition to increased risk of perinatal mortality.…”

Section: Introductionmentioning

confidence: 99%

“…Mortality rates reported in the literature vary between 30 and 56%. [8][9][10][11][12] We conducted a case note review to assess the maternal and fetal outcomes of pregnant women with PH attending for care at a tertiary centre in south India. [5][6][7][8][9][10][11][12] Advances in medical care have led to an increase in the life expectancy of patients with PH.…”

Section: Introductionmentioning

confidence: 99%

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Outcome of pregnancies in women with pulmonary hypertension: a single‐centre experience from South India

Keepanasseril

Pillai

Yavanasuriya

et al. 2019

BJOG

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Objective To study maternal complications and pregnancy outcome in women with pulmonary hypertension, attending a tertiary centre in south India.Study design Retrospective observational study.Setting Tertiary centre in south India.Population Pregnant women with pulmonary hypertension.Method Data regarding demographics, clinical course, medication received, and echocardiographic diagnosis regarding pulmonary hypertension and antenatal care received were collected from the records. Details of labour and delivery, and postpartum follow up were retrieved. We compared the outcome based on the presence or absence of cyanosis and right ventricular systolic pressure levels.Main outcome measures Maternal mortality, occurrence of complications such as heart failure, fetal growth restriction.Results There were 81 pregnancies in 73 women with pulmonary hypertension. The majority of them had pulmonary hypertension secondary to congenital heart disease (80.8%); 17.8% had Eisenmenger syndrome. An advanced pulmonary artery hypertension (PAH) medication, sildenafil, was administered in 25 (31.3%) pregnancies. There were four maternal deaths, of which three had Eisenmenger syndrome. Heart failure complicated 6.3% and fetal growth restriction 26.3% of pregnancies. Morbidity was significantly increased in women with pulmonary hypertension associated with a cyanotic cardiac lesion or with right ventricular systolic pressure >70 mmHg.Conclusion Despite advances in care, mortality in pregnant women with pulmonary hypertension is a matter of concern, especially in those with Eisenmenger syndrome. Multidisciplinary team management in tertiary centres and the use of advanced PAH medications even in low-to middle-income countries with limited resources, could lead to a reduction in morbidity and mortality related to pulmonary hypertension.Keywords Eisenmenger syndrome, pregnancy, pulmonary hypertension.Tweetable abstract Multidisciplinary care and use of new medication may improve outcomes in pregnant women with pulmonary hypertension.Please cite this paper as: Keepanasseril A, Pillai AA, Yavanasuriya J, Raj A, Satheesh S, Kundra P. Outcome of pregnancies in women with pulmonary hypertension: a single-centre experience from South India. BJOG 2019; 126 (S4): 43-49.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Outcome of pregnancies in women with pulmonary hypertension: a single‐centre experience from South India

Keepanasseril

Pillai

Yavanasuriya

et al. 2019

BJOG

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“…For ES patients, a multidisciplinary approach is imperative and surgery should preferably be performed only at centers with expertise in the management of such patients, or in case of emergent or urgent situations, caregivers should seek consultation with expert centers throughout care. Pregnancy is still associated with a significant risk of both maternal and fetal mortality even though recent reports show better outcome than previously described as specialized care during pregnancy and delivery is now available [30,31]. However, given the severity and the high rate of complications associated with pregnancy, most PAH-CHD patients should still be advised against pregnancy.…”

Section: General Managementmentioning

confidence: 99%

The Changing Landscape of Pulmonary Arterial Hypertension in the Adult with Congenital Heart Disease

Dissel

Mulder

Bouma

2017

JCM

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Pulmonary arterial hypertension associated with congenital heart disease (PAH-CHD) is a common type of pulmonary arterial hypertension (PAH) and a frequent complication of congenital heart disease (CHD). PAH-CHD represents a heterogeneous patient population and it is important to distinguish between the underlying cardiac defects considering the prognostic and therapeutic implications. Improved interventional techniques have enabled repair or palliation of most cardiac defects, though a substantial number of patients remain at high risk for PAH after closure. Traditionally, the treatment and management of PAH-CHD patients has been limited to palliative and supportive care, and based on expert opinion rather than clinical trials. Recently, however, the availability of advanced PAH-specific treatment has opened up a new field for the clinical management of this condition. Nevertheless, there is limited evidence on the optimal therapeutic approach for PAH-CHD. Herein, we discuss the current and novel therapeutic options for PAH-CHD as well as highlight several challenges in the clinical management at present.

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“…По литературным данным, среди пациенток с сер-дечно-сосудистыми заболеваниями кесарево сечение проводится в 25-51% случаев [15][16][17]. В ряде исследо-ваний частота кесарева сечения при аортопатиях достигает 51% [15].…”

Section: рис 4 структура патологии новорожденныхunclassified

Pregnancy and Delivery Management of Women With Aorta and Aortic Valve Pathology

Иртюга¹,

Мгдесян²,

Моисеева³

2017

Russ J Cardiol

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Совершенствование кардиохирургической тех-ники, рост числа успешно прооперированных детей с врожденными пороками сердца способствуют росту в последние десятилетия количества беременных женщин с различной сердечно-сосудистой патоло-гией.Известно, что физиологическая беременность сопряжена с рядом гемодинамических изменений, ОСОБЕННОСТИ ВЕДЕНИЯ БЕРЕМЕННОСТИ И РОДОВ У ПАЦИЕНТОК С ПАТОЛОГИЕЙ АОРТЫ И АОРТАЛЬНОГО КЛАПАНАИртюга О. Б., Мгдесян К. О., Моисеева О. М.Цель. Проанализировать особенности клинического течения беременности, родов и послеродового периода у женщин с патологией аортального клапана (АК) и аорты. Материал и методы. В период с января 2012 по декабрь 2014гг в условиях специализированного перинатального центра ФГБУ СЗФМИЦ им. В. А. Алма-зова в проспективное когортное исследование включено 56 пациенток со струк-турной патологией аорты и АК. Средний возраст обследованных пациенток составил 29±4,5 лет (от 18 до 38 лет). Всем пациенткам проводилось эхокардио-графическое исследование (ЭхоКГ) на аппарате Vivid 7 GE по стандартному протоколу. Уровень N-терминального натрийуретического пропептида (NTproBNP) определяли методом электрохемилюминесценции посредством ана-лизатора Cobas e 411 (Roche, Швейцария) на 34±6 неделе беременности. Результаты. Наиболее частой патологией в анализируемой группе были аор-тальный стеноз и коарктация аорты. Основной причиной развития патологии АК явился врожденный порок сердца (ВПС) -двустворчатый АК (БАК). Ослож-нения со стороны сердечно-сосудистой системы встречались в 9 случаях (16%) и были связаны с появлением желудочковых нарушений ритма высоких градаций и проявлениями сердечной недостаточности потребовавших назна-чения медикаментозной терапии (10,7%, n=6). Уровень NT-proBNP превысил 125 пг/мл у 12 пациенток (21,4%) и в среднем составил 330,3±54,7 пг/мл, у пациенток с повышенным NT-proBNP осложнения со стороны сердечно-сосудистой системы во время беременности встречались в 3 раза чаще. У 25 пациенток (44,6%) зарегистрированы те или иные акушерские осложнения в основном в 3 триместре беременности. Несмотря на клинически значимую кардиальную патологию, пациентки родоразрешены в доношенном сроке 38,6±1,5 недели. После родоразрешения не зарегистрированы случаи про-грессирования сердечной недостаточности, либо развитие других осложне-ний со стороны сердечно-сосудистой системы. Заключение. Для женщин с патологией аорты и АК характерен благоприят-ный прогноз беременности и родов при условии наблюдения в специализиро-ванных центрах. Results. The most common pathology in the analyzed group were aortic stenosis and aortic coarctation. The main cause of AV pathology was inborn defect (IHD) -bicuspid AV (BAV). Complications in cardiovascular functioning developed in 9 cases (16%) and were related to ventricular rhythm disorders of high grades and signs of heart failure with need of medication treatment (10,7%, n=6). Level of NTproBNP was higher than 125 pg/mL in 12 patients (21,4%) and its mean value was 330,3±54,7 pg/mL; in women with increased NT-proBNP complications in cardiovascular...

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Pregnancy outcomes in patients with pulmonary arterial hypertension associated with congenital heart disease

Abstract: Outcome of pregnancy in women with PAH-CHD is better than previously reported, with only 5% maternal mortality in our cohort. However, because of the severity of heart failure and the high rate of neonatal complications, patients should still be advised against pregnancy.

Cited by 78 publications

References 25 publications

Outcome of pregnancies in women with pulmonary hypertension: a single‐centre experience from South India

Outcome of pregnancies in women with pulmonary hypertension: a single‐centre experience from South India

The Changing Landscape of Pulmonary Arterial Hypertension in the Adult with Congenital Heart Disease

Pregnancy and Delivery Management of Women With Aorta and Aortic Valve Pathology

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