Challenges of the Transcatheter Approach to Mitral Valve Replacement in Women Contemplating Pregnancy.
Challenges of the Transcatheter Approach to Mitral Valve Replacement in Women Contemplating Pregnancy.
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打算怀孕的女性经导管二尖瓣置换术面临的挑战。
DOI：
10.1161/circinterventions.120.010227
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发表时间：
2020
期刊：
影响因子：
--
通讯作者：
Sutton,NadiaR
中科院分区：
文献类型：
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作者：
Warnes,CaroleA;Sutton,NadiaR
患有二尖瓣疾病的年轻女性在选择二尖瓣假体时面临困境，并且没有完美的解决方案。一般来说，组织假体在计划怀孕的女性中是优选的，但在需要重复干预的年轻患者中退化更快。有些人甚至在第一次怀孕前就可能经历结构性瓣膜退化，在第二次手术时，经常建议使用机械瓣膜。如果他们在结构性瓣膜退化之前就有了孩子，并在再次手术时死亡，那么他们的孩子就没有了亲生母亲。在妊娠期明显的血栓前状态下，机械瓣膜伴随的必要抗凝治疗会对母体和胎儿造成重大风险。3无论选择何种抗凝策略，风险包括母体出血、瓣膜血栓形成、流产和胎儿死亡。3登记研究报告称，患有机械心脏瓣膜的女性只有58%的机会获得无并发症的妊娠和活产。第三、四条
Young women with mitral valve disease face a dilemma when selecting a mitral prosthesis, and there is no perfect solution. In general, tissue prostheses are preferable in women who plan to become pregnant but degenerate more quickly in young patients necessitating a repeat intervention. 1 Some may experience structural valve deterioration even before their first pregnancy, and at the time of a second operation, a mechanical valve is frequently advised. 2 If they have babies before structural valve deterioration and die at reoperation, they leave children without a biological mother. The necessary anticoagulation that accompanies a mechanical valve poses significant maternal and fetal risks during the markedly prothrombotic state of pregnancy. 3 Whichever anticoagulant strategy is selected, risks include maternal hemorrhage, valve thrombosis, miscarriage, and fetal demise. 3 Registries report that women with mechanical heart valves have only a 58% chance of having an uncomplicated pregnancy with a live birth. 3, 4