Mitral stenosis in pregnancy: a four-year experience at King Edward VIII Hospital, Durban, South Africa
Mitral stenosis in pregnancy: a four-year experience at King Edward VIII Hospital, Durban, South Africa
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DOI：
10.1111/j.1471-0528.2000.tb10395.x
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发表时间：
2000-08-01
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影响因子：
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通讯作者：
Kleinschmidt, I
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作者：
Desai, DK;Adanlawo, M;Kleinschmidt, I
目的前瞻性评价妊娠期二尖瓣狭窄，重点是持续症状的妇女，设置爱德华八世国王医院，三级转诊产科单位。平均年龄为27岁，38名女性（30%）为妊娠晚期。78例（61%）女性在妊娠晚期进行了首次心脏评估。其中54名女性（42%）在指数妊娠中首次诊断为二尖瓣狭窄。29例（23%）既往接受过二尖瓣切开术。19名妇女（15%）在怀孕期间患上高血压，其中10人有先兆子痫。63名女性（49%）的二尖瓣面积小于或等于1.2 cm（2），其中11名患有严重二尖瓣狭窄（二尖瓣面积小于或等于0.8 cm（2））。12例女性患者出现房颤。大多数妇女（87%）需要药物治疗来控制心率。持续症状妇女的结局37名妇女（29%）仍有症状，其中11名（9%）二尖瓣钙化。其余26例患者在妊娠期间接受了二尖瓣球囊扩张术，其中20例患者接受了二尖瓣球囊扩张术，效果良好（产前16例;产后4例）。在7名女性中，由于晚期早产（n = 5）、胎儿窘迫（n = 1）和早产伴胎儿窘迫（n = 1），未进行计划的球囊二尖瓣切开术。这七个，再加上11钙化二尖瓣狭窄，保守治疗效果良好。产妇并发症51%的产妇并发症，大多数发生在他们最初入院。肺水肿是最常见的。多元逻辑回归分析显示，通过超声多普勒测量二尖瓣面积评估狭窄的严重程度是母体肺水肿的最有力预测因素。其他因素是产前晚出现，存在的症状之前，指数怀孕和心脏病的诊断，第一次在指数pregnancy.Conclusion尽管严重的疾病，妇女与持续的症状治疗无论是通过球囊二尖瓣切开术在可行的情况下，或保守密切的非侵入性监测，有一个令人满意的胎儿和母亲的结果。
Objective To evaluate prospectively mitral stenosis in pregnancy with emphasis on women with persistent symptoms.Setting King Edward VIII Hospital, a tertiary referral obstetric unit.Participants One hundred and twenty-eight consecutive women with mitral. stenosis.Demographics The mean age was 27 years and 38 women (30%) were primigravidae. Seventy-eight (61%) women had their first cardiac evaluation in the third trimester. Fifty-four women (42%) of these women had mitral stenosis diagnosed for the first time in the index pregnancy. Twenty-nine (23%) had a previous mitral valvulotomy. Nineteen women (15%) developed hypertension during pregnancy 10 of whom had pre-eclampsia. Sixty-three women (49%) had a mitral valve area of less than or equal to 1.2 cm(2) with 11 having critical mitral stenosis (mitral valve area less than or equal to 0.8 cm(2)). Atrial fibrillation was present in 12 women. Most women (87%) required medical therapy to control the heart rate.Outcome in persistent symptomatic women Intervention was considered in 37 women (29%) who remained symptomatic, 11 (9%) of whom had a calcified mitral valve. The remaining 26 women were scheduled for balloon mitral valvulotomy during pregnancy, 20 of whom had balloon mitral valvulotomy with good effect (16 antepartum; 4 postpartum). In seven women, scheduled balloon mitral valvulotomy was not performed because of advanced preterm labour (n = 5), fetal distress (n = 1) and preterm labour with fetal distress (n = 1). These seven, together with the 11 with calcific mitral stenosis, were managed conservatively with good outcome.Maternal complications Fifty-one percent had maternal complications, the majority occurring at their initial admission to hospital. Pulmonary oedema was the most frequent. Multiple logistic regression analysis showed that the severity of stenosis assessed by measurement of the mitral valve area by echo-Doppler was the most powerful predictor of maternal pulmonary oedema. The other factors were late antenatal presentation, presence of symptoms prior to the index pregnancy and diagnosis of cardiac disease for the first time in the index pregnancy.Conclusion Despite serious disease, women with persistent symptoms treated either by balloon mitral valvulotomy where feasible, or conservatively with close noninvasive monitoring, had a satisfactory fetal and maternal outcome.