The impact of pulmonary valve replacement on pregnancy outcomes in women with tetralogy of Fallot
The impact of pulmonary valve replacement on pregnancy outcomes in women with tetralogy of Fallot
复制标题
肺动脉瓣置换术对法洛四联症女性妊娠结局的影响
DOI：
10.1016/j.ijcard.2021.02.006
复制
发表时间：
2021
期刊：
影响因子：
3.5
通讯作者：
Rachel M Wald
中科院分区：
文献类型：
--
作者：
Kenichiro Yamamura;Valeria Duarte ;Gauri Rani Karur;Julia Graf;Kate Hanneman;Tal Geva;Anne Marie Valente;Rachel M Wald
研究背景妊娠合并法洛四联症修补术(RTOF)的孕妇有更高的不良结局风险。尽管孕前肺瓣膜置换术(PVR)在一些妇女中可能被认为可以降低风险，但缺乏公开的数据来支持这一做法。我们的目的是探讨孕前PVR对rTOF妊娠结局的影响。方法如果妊娠3年内完成了rTOF和妊娠前后心血管磁共振成像(CMR)研究，则纳入其中。受试者根据孕前CMR时PVR的存在(+)或不存在(−)进行比较。记录妊娠结局(心血管、产科和胎儿/新生儿)。结果29名受试者中，7名PVR阳性，22名PVR-。与孕前相比，妊娠后PVR组的右室舒张期末容量(RVEDVi)(157m±2.28比166m l/m~2)和收缩末期容量(RVESVi)(82m±0.17比89m±20m l/m~2，P=0.003)显著增加，但右室射血分数、右室质量和左心室测量值无明显变化。在PVR+组，妊娠前后的RV测量没有间隔变化。PVR-超过PVR+女性的RVESVi间期变化率(+3.7%±15.0vs2.2%±15.0%/年，p=0.03)。PVR+和PVR-妇女的妊娠结局没有差异。结论在我们的队列中，不同PVR状态的妊娠结局没有差别。PVR+患者右室容量不变，PVR-女性患者RV间歇性扩张。对更大范围的人群和更长时间的随访的额外研究可能进一步为孕前PVR的临床实践提供信息。
BackgroundPregnant women with repaired tetralogy of Fallot (rTOF) are at increased risk of adverse outcomes. Although pre-pregnancy pulmonary valve replacement (PVR) may be considered in some women to attenuate risk, published data to support this practice are lacking. Our objective was to explore the impact of pre-pregnancy PVR on pregnancy outcomes in rTOF.MethodsWomen with rTOF and cardiovascular magnetic resonance imaging (CMR) before and after pregnancy were included if CMR studies were completed within 3 years of pregnancy. Subjects were compared according to presence (+) or absence (−) of PVR at pre-pregnancy CMR. Pregnancy outcomes (cardiovascular, obstetric, and fetal/neonatal) were documented.ResultsOf the 29 study women identified, 7 were PVR+ and 22 were PVR-. Post-pregnancy, the PVR- group demonstrated interval increase in indexed right ventricular end-diastolic volumes (RVEDVi) (157 ± 28 versus 166 ± 33 ml/m2,p= 0.003) and end-systolic volumes (RVESVi) (82 ± 17 versus 89 ± 20 ml/m2, p = 0.003) as compared with pre-pregnancy, but no significant change in RV ejection fraction, RV mass, or left ventricular measurements. In the PVR+ group, there were no interval changes in RV measurements pre-versus post pregnancy. Interval rate of change in RVESVi of PVR- exceeded PVR+ women (+3.7 ± 5.0 versus −2.2 ± 5.0 ml/m2/year,p= 0.03). Pregnancy outcomes did not differ in PVR+ versus PVR- women.ConclusionsPregnancy outcomes did not differ according to PVR status in our cohort. While RV volumes remained unchanged in PVR+ women, interval RV dilation was observed in PVR- women. Additional study of a larger population with longer follow-up may further inform clinical practice regarding pre-pregnancy PVR.