Advances in the prevention and management of heart disease in pregnancy_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

ZHAO Zhili ¹ , LI Tao ² , ZENG Ling ¹ ,  QIAN Yongjun ²

1. Department of Thoracic ICU, Critical Care Medicine, West China Hospital, Sichuan University, Chengdu, 610041, P.R.China;
2. Department of Cardiovascular Surgery and National Clinical Research Center for Geriatrics, West China Hospital, Sichuan University, Chengdu, 610041, P.R.China;

Corresponding author：

QIAN Yongjun, Email: qianyongjun@scu.edu.cn

Keywords：

Pregnancy; heart disease; prevention; management; perioperation; review

DOI：

10.7507/1007-4848.202001053

Video：

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With the opening of the two child policy in China, the number of pregnant women has increased. Pregnancy has a huge impact on the cardiovascular system, and heart disease during pregnancy increases the risk of maternal heart failure and death, intrauterine growth retardation, and the risk of complications such as premature birth. Pregnancy with heart disease ranks first among indirect obstetric deaths in China. Reducing maternal mortality is a global goal of the World Health Organization. Thus, to strengthen the prevention and management of patients with critical heart disease during pregnancy is important. However, clinical decision-making and management of pregnant women with heart disease is still controversial. This article combines relevant literature of pregnancy and heart disease published in recent years and reviews of relevant diagnostic and therapeutic methods, to provide clinical reference for pregnant women with heart disease preventive care and management of the whole strategy.

Citation： ZHAO Zhili, LI Tao, ZENG Ling, QIAN Yongjun. Advances in the prevention and management of heart disease in pregnancy. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2020, 27(11): 1357-1361. doi: 10.7507/1007-4848.202001053 Copy

1.	Presbitero P. 2018 ESC guidelines for the management of cardiovascular diseases during pregnancy: what's new? G Ital Cardiol (Rome), 2019, 20(9): 469-474.
2.	张军. 妊娠合并心脏病的多学科(分层)管理. 中国全科医学, 2019, 22(3): 10-15.
3.	Burlingame J, Horiuchi B, Ohana P, et al. The contribution of heart disease to pregnancy-related mortality according to the pregnancy mortality surveillance system. J Perinatol, 2012, 32(3): 163-169.
4.	Cauldwell M, Baris L, Roos-Hesselink JW, et al. Ischaemic heart disease and pregnancy. Heart, 2019, 105(3): 189-195.
5.	郑兴, 吴兆红. 妊娠合并先天性心脏病的诊疗进展. 中华产科急救电子杂志, 2018, 7(4): 243-246.
6.	Russo MG, Paladini D, Pacileo G, et al. Changing spectrum and outcome of 705 fetal congenital heart disease cases: 12 years, experience in a third-level center. J Cardiovasc Med (Hagerstown), 2008, 9(9): 910-915.
7.	Hayward RM, Foster E, Tseng ZH. Maternal and fetal outcomes of admission for delivery in women with congenital heart disease. JAMA Cardiol, 2017, 2(6): 664-671.
8.	Roos-Hesselink J, Baris L, Johnson M, et al. Pregnancy outcomes in women with cardiovascular disease: evolving trends over 10 years in the ESC Registry of Pregnancy and Cardiac disease (ROPAC). Eur Heart J, 2019, 40(47): 3848-3855.
9.	Hebson C, Saraf A, Book WM. Risk assessment and management of the mother with cardiovascular disease. Clin Perinatol, 2016, 43(1): 1-22.
10.	Silversides CK, Grewal J, Mason J, et al. Pregnancy outcomes in women with heart disease: The CARPREG Ⅱ Study. J Am Coll Cardiol, 2018, 71(21): 2419-2430.
11.	Fu Q, Lin J. Predictive accuracy of three clinical risk assessment systems for cardiac complications among Chinese pregnant women with congenital heart disease. Int J Gynaecol Obstet, 2016, 134(2): 140-144.
12.	Dolk H, McCullough N, Callaghan S, et al. Risk factors for congenital heart disease: The Baby Hearts Study, a population-based case-control study. PLoS One, 2020, 15(2): e0227908.
13.	Shapero KS, Desai NR, Elder RW, et al. Cardio-obstetrics: Recognizing and managing cardiovascular complications of pregnancy. Cleve Clin J Med, 2020, 87(1): 43-52.
14.	Elkayam U, Jalnapurkar S, Barakkat MN, et al. Pregnancy-associated acute myocardial infarction: a review of contemporary experience in 150 cases between 2006 and 2011. Circulation, 2014, 129(16): 1695-1702.
15.	Tripathi B, Kumar V, Pitiliya A, et al. Trends in incidence and outcomes of pregnancy-related acute myocardial infarction (from a nationwide inpatient sample database). Am J Cardiol, 2019, 123(8): 1220-1227.
16.	Fletcher E, Knox EW, Morton P. Acute myocardial infarction in pregnancy. Br Med J, 1967, 3(5565): 586-588.
17.	Smilowitz NR, Gupta N, Guo Y, et al. Acute myocardial infarction during pregnancy and the puerperium in the United States. Mayo Clin Proc, 2018, 93(10): 1404-1414.
18.	Frishman WH, Elkayam U, Aronow WS. Cardiovascular drugs in pregnancy. Cardiol Clin, 2012, 30(3): 463-491.
19.	Argentiero D, Savonitto S, D'Andrea P, et al. Ticagrelor and tirofiban in pregnancy and delivery: beyond labels. J Thromb Thrombolysis, 2020, 49(1): 145-148.
20.	Liu YY, Li HY, Jiang WJ, et al. Treatment of patients with aortic disease during pregnancy and after delivery. J Int Med Res, 2017, 45(4): 1359-1368.
21.	Kamel H. Response by Kamel to letter regarding article, "pregnancy and the risk of aortic dissection or rupture: a cohort-crossover analysis". Circulation, 2017, 135(12): e782.
22.	Roman MJ, Pugh NL, Hendershot TP, et al. Aortic complications associated with pregnancy in marfan syndrome: The NHLBI National Registry of Genetically Triggered Thoracic Aortic Aneurysms and Cardiovascular Conditions (GenTAC). J Am Heart Assoc, 2016, 5(8): e004052.
23.	De Martino A, Morganti R, Falcetta G, et al. Acute aortic dissection and pregnancy: Review and meta-analysis of incidence, presentation, and pathologic substrates. J Card Surg, 2019, 34(12): 1591-1597.
24.	European Society of Gynecology (ESG), Association for European Paediatric Cardiology (AEPC), German Society for Gender Medicine (DGesGM), et al. ESC Guidelines on the management of cardiovascular diseases during pregnancy: the Task Force on the Management of Cardiovascular Diseases during Pregnancy of the European Society of Cardiology (ESC). Eur Heart J, 2011, 32(24): 3147-3197.
25.	Latt KK, Vasiliyev KN, Bayandin NL, et al. Risk factors of surgical treatment of acute aortic dissection type A (in Russian only). Khirurgiia (Mosk), 2019, 3: 15-20.
26.	Shu C, Fang K, Dardik A, et al. Pregnancy-associated type B aortic dissection treated with thoracic endovascular aneurysm repair. Ann Thorac Surg, 2014, 97(2): 582-587.
27.	Stout KK, Otto CM. Pregnancy in women with valvular heart disease. Heart, 2007, 93(5): 552-558.
28.	Anthony J, Osman A, Sani MU. Valvular heart disease in pregnancy. Cardiovasc J Afr, 2016, 27(2): 111-118.
29.	Tsiaras S, Poppas A. Mitral valve disease in pregnancy: outcomes and management. Obstet Med, 2009, 2(1): 6-10.
30.	Benatta NF, Batouche DD, Djazouli MA, et al. Management of mitral valve stenosis during pregnancy at the Oran University Hospital Center: About 83 cases. Ann Cardiol Angeiol (Paris), 2018, 67(4): 274-279.
31.	Palacios IF, Block PC, Wilkins GT, et al. Percutaneous mitral balloon valvotomy during pregnancy in a patient with severe mitral stenosis. Cathet Cardiovasc Diagn, 1988, 15(2): 109-111.
32.	Requena Laviña M, Cosío FG, Fernández-Yáñez J, et al. Treatment of mitral stenosis with propranolol in pregnancy and the puerperium. Med Clin (Barc), 1985, 85(10): 412-414.
33.	Sharma JB, Yadav V, Mishra S, et al. Comparative study on maternal and fetal outcome in pregnant women with rheumatic heart disease and severe mitral stenosis undergoing percutaneous balloon mitral valvotomy before or during pregnancy. Indian Heart J, 2018, 70(5): 685-689.
34.	Pedersen MW, Groth KA, Mortensen KH, et al. Clinical and pathophysiological aspects of bicuspid aortic valve disease. Cardiol Young, 2019, 29(1): 1-10.
35.	Ducas RA, Javier DA, D'Souza R, et al. Pregnancy outcomes in women with significant valve disease: a systematic review and meta-analysis. Heart, 2020, 106(7): 512-519.
36.	Nwabuobi C, McDowell M, Običan S. Severe bicuspid aortic stenosis in pregnancy: balancing the risk of prematurity and maternal mortality. Cardiol Young, 2018, 28(5): 756-758.

1. Presbitero P. 2018 ESC guidelines for the management of cardiovascular diseases during pregnancy: what's new? G Ital Cardiol (Rome), 2019, 20(9): 469-474.
2. 张军. 妊娠合并心脏病的多学科(分层)管理. 中国全科医学, 2019, 22(3): 10-15.
3. Burlingame J, Horiuchi B, Ohana P, et al. The contribution of heart disease to pregnancy-related mortality according to the pregnancy mortality surveillance system. J Perinatol, 2012, 32(3): 163-169.
4. Cauldwell M, Baris L, Roos-Hesselink JW, et al. Ischaemic heart disease and pregnancy. Heart, 2019, 105(3): 189-195.
5. 郑兴, 吴兆红. 妊娠合并先天性心脏病的诊疗进展. 中华产科急救电子杂志, 2018, 7(4): 243-246.
6. Russo MG, Paladini D, Pacileo G, et al. Changing spectrum and outcome of 705 fetal congenital heart disease cases: 12 years, experience in a third-level center. J Cardiovasc Med (Hagerstown), 2008, 9(9): 910-915.
7. Hayward RM, Foster E, Tseng ZH. Maternal and fetal outcomes of admission for delivery in women with congenital heart disease. JAMA Cardiol, 2017, 2(6): 664-671.
8. Roos-Hesselink J, Baris L, Johnson M, et al. Pregnancy outcomes in women with cardiovascular disease: evolving trends over 10 years in the ESC Registry of Pregnancy and Cardiac disease (ROPAC). Eur Heart J, 2019, 40(47): 3848-3855.
9. Hebson C, Saraf A, Book WM. Risk assessment and management of the mother with cardiovascular disease. Clin Perinatol, 2016, 43(1): 1-22.
10. Silversides CK, Grewal J, Mason J, et al. Pregnancy outcomes in women with heart disease: The CARPREG Ⅱ Study. J Am Coll Cardiol, 2018, 71(21): 2419-2430.
11. Fu Q, Lin J. Predictive accuracy of three clinical risk assessment systems for cardiac complications among Chinese pregnant women with congenital heart disease. Int J Gynaecol Obstet, 2016, 134(2): 140-144.
12. Dolk H, McCullough N, Callaghan S, et al. Risk factors for congenital heart disease: The Baby Hearts Study, a population-based case-control study. PLoS One, 2020, 15(2): e0227908.
13. Shapero KS, Desai NR, Elder RW, et al. Cardio-obstetrics: Recognizing and managing cardiovascular complications of pregnancy. Cleve Clin J Med, 2020, 87(1): 43-52.
14. Elkayam U, Jalnapurkar S, Barakkat MN, et al. Pregnancy-associated acute myocardial infarction: a review of contemporary experience in 150 cases between 2006 and 2011. Circulation, 2014, 129(16): 1695-1702.
15. Tripathi B, Kumar V, Pitiliya A, et al. Trends in incidence and outcomes of pregnancy-related acute myocardial infarction (from a nationwide inpatient sample database). Am J Cardiol, 2019, 123(8): 1220-1227.
16. Fletcher E, Knox EW, Morton P. Acute myocardial infarction in pregnancy. Br Med J, 1967, 3(5565): 586-588.
17. Smilowitz NR, Gupta N, Guo Y, et al. Acute myocardial infarction during pregnancy and the puerperium in the United States. Mayo Clin Proc, 2018, 93(10): 1404-1414.
18. Frishman WH, Elkayam U, Aronow WS. Cardiovascular drugs in pregnancy. Cardiol Clin, 2012, 30(3): 463-491.
19. Argentiero D, Savonitto S, D'Andrea P, et al. Ticagrelor and tirofiban in pregnancy and delivery: beyond labels. J Thromb Thrombolysis, 2020, 49(1): 145-148.
20. Liu YY, Li HY, Jiang WJ, et al. Treatment of patients with aortic disease during pregnancy and after delivery. J Int Med Res, 2017, 45(4): 1359-1368.
21. Kamel H. Response by Kamel to letter regarding article, "pregnancy and the risk of aortic dissection or rupture: a cohort-crossover analysis". Circulation, 2017, 135(12): e782.
22. Roman MJ, Pugh NL, Hendershot TP, et al. Aortic complications associated with pregnancy in marfan syndrome: The NHLBI National Registry of Genetically Triggered Thoracic Aortic Aneurysms and Cardiovascular Conditions (GenTAC). J Am Heart Assoc, 2016, 5(8): e004052.
23. De Martino A, Morganti R, Falcetta G, et al. Acute aortic dissection and pregnancy: Review and meta-analysis of incidence, presentation, and pathologic substrates. J Card Surg, 2019, 34(12): 1591-1597.
24. European Society of Gynecology (ESG), Association for European Paediatric Cardiology (AEPC), German Society for Gender Medicine (DGesGM), et al. ESC Guidelines on the management of cardiovascular diseases during pregnancy: the Task Force on the Management of Cardiovascular Diseases during Pregnancy of the European Society of Cardiology (ESC). Eur Heart J, 2011, 32(24): 3147-3197.
25. Latt KK, Vasiliyev KN, Bayandin NL, et al. Risk factors of surgical treatment of acute aortic dissection type A (in Russian only). Khirurgiia (Mosk), 2019, 3: 15-20.
26. Shu C, Fang K, Dardik A, et al. Pregnancy-associated type B aortic dissection treated with thoracic endovascular aneurysm repair. Ann Thorac Surg, 2014, 97(2): 582-587.
27. Stout KK, Otto CM. Pregnancy in women with valvular heart disease. Heart, 2007, 93(5): 552-558.
28. Anthony J, Osman A, Sani MU. Valvular heart disease in pregnancy. Cardiovasc J Afr, 2016, 27(2): 111-118.
29. Tsiaras S, Poppas A. Mitral valve disease in pregnancy: outcomes and management. Obstet Med, 2009, 2(1): 6-10.
30. Benatta NF, Batouche DD, Djazouli MA, et al. Management of mitral valve stenosis during pregnancy at the Oran University Hospital Center: About 83 cases. Ann Cardiol Angeiol (Paris), 2018, 67(4): 274-279.
31. Palacios IF, Block PC, Wilkins GT, et al. Percutaneous mitral balloon valvotomy during pregnancy in a patient with severe mitral stenosis. Cathet Cardiovasc Diagn, 1988, 15(2): 109-111.
32. Requena Laviña M, Cosío FG, Fernández-Yáñez J, et al. Treatment of mitral stenosis with propranolol in pregnancy and the puerperium. Med Clin (Barc), 1985, 85(10): 412-414.
33. Sharma JB, Yadav V, Mishra S, et al. Comparative study on maternal and fetal outcome in pregnant women with rheumatic heart disease and severe mitral stenosis undergoing percutaneous balloon mitral valvotomy before or during pregnancy. Indian Heart J, 2018, 70(5): 685-689.
34. Pedersen MW, Groth KA, Mortensen KH, et al. Clinical and pathophysiological aspects of bicuspid aortic valve disease. Cardiol Young, 2019, 29(1): 1-10.
35. Ducas RA, Javier DA, D'Souza R, et al. Pregnancy outcomes in women with significant valve disease: a systematic review and meta-analysis. Heart, 2020, 106(7): 512-519.
36. Nwabuobi C, McDowell M, Običan S. Severe bicuspid aortic stenosis in pregnancy: balancing the risk of prematurity and maternal mortality. Cardiol Young, 2018, 28(5): 756-758.

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