Abstract
Objectives
Left heart obstruction in pregnancy is associated with higher rates of morbidity/mortality.
The primary aim of this study was to evaluate maternal cardiovascular, obstetric,
and fetal/infant events in pregnant women with left heart obstruction.
Study design
Pregnant women with current or repaired left heart obstruction were retrospectively
analyzed (2000–2014): mitral stenosis, left ventricular outflow tract obstruction
(subvalvar, valvar, supravalvar), and coarctation of the aorta. Maternal cardiovascular
events were defined as: heart failure, arrhythmia, urgent/emergent cardiac surgery
or percutaneous transcathter intervention, transient ischemic attack/cerebrovascular
accident, and death up to 6 months postpartum.
Results
There were 90 pregnancies in 67 women (29 ± 7 years old) who had 15 maternal cardiovascular events. Isolated mitral stenosis (n = 6) or >1 serial left heart obstructive lesion (n = 6) were the source of the event in the majority pregnancies. Women with isolated mitral
stenosis had increased cardiovascular events compared to other single left heart obstructive
lesions (OR 18.6, 95% CI: 3.8–91.1). If >1 serial obstructive lesion was present,
there was also an increased risk of maternal cardiovascular events (OR 6.8, 95% CI:
1.6–29.1), however isolated mitral stenosis carried similar risk to serial left heart
obstructive lesions (OR 2.7, 95% CI: 0.7–11.2).
Baseline characteristics associated with events included: New York Heart Association
functional class >2 (27% vs. 0, p < 0.001), any current left heart obstruction (73% vs. 36%, p = 0.01), severe left heart obstruction (40% vs. 29%, p < 0.001), and higher Cardiac Disease in Pregnancy (“CARPREG”) score (1.2 ± 0.7 vs. 0.5 ± 0.7, p = 0.01). There was no difference in rate of obstetric/fetal/infant complications in
women with cardiovascular events; however, term birth weight was lower (2.7 ± 0.5 vs. 3.1 ± 0.6 kg, p = 0.01). There was no maternal mortality.
Conclusions
Isolated mitral stenosis and serial (>1) left heart obstructive lesions carry the
highest risk of maternal cardiovascular events. We are the first to show higher event
rates in women with serial left heart obstructive lesions. The data supports the need
for specialized and experienced high-risk obstetric-cardiac teams to care for women
with left heart obstruction, and demonstrates excellent outcomes in a complex cohort
of pregnant women with all types of left heart obstruction.
Keywords
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References
- Prospective multicenter study of pregnancy outcomes in women with heart disease.Circulation. 2001; 104: 515-521
- Echocardiographic assessment of valve stenosis: EAE/ASE recommendations for clinical practice.J Am Soc Echocardiogr. 2009; 22: 1-23
- ACC/AHA 2008 guidelines for the management of adults with congenital heart disease.J Am Coll Cardiol. 2008; 52: e143-e263
- The development complex of parachute mitral valve, supravalvular ring of the left atrium, subaortic stenosis, and coarctation of the aorta.Am J Cardiol. 1963; : 714-725
- Serial study of factors influencing changes in cardiac output during human pregnancy.Am J Physiol. 1989; 256: H1060-H1065
- Blood volume changes in pregnancy and the puerperium III. Whole body and large vessel hematocrits in pregnant and non-pregnant women.Am J Obstet Gynecol. 1964; 88: 391-395
- Early pregnancy changes in hemodynamics and volume homeostasis are consecutive adjustments trigged by a primary falling systemic vascular tone.Am J Obstetr Gynecol. 1993; 169: 1382-1392
- 2014 AHA/ACC guideline for the management of patients with valvular heart disease.J Am Coll Cardiol. 2014; 63: e57-e185
- Cardiac risk in pregnant women with rheumatic mitral stenosis.Am J Cardiol. 2003; 91: 1382-1385
- The effect of valvular heart disease on maternal and fetal outcome of pregnancy.J Am Coll Cardiol. 2001; 37: 893-899
- Predictors of pregnancy complications in women with congenital heart disease.Eur Heart J. 2010; 31: 2124-2132
- Risk of complications during pregnancy in women with congenital aortic stenosis.Int J Cardiol. 2008; 23: 240-246
- Outcome of pregnancy in women after pulmonary autograft valve replacement for congenital aortic valve disease.J Heart Valve Dis. 2007; 16: 398-403
- Aortic stenosis in pregnancy.Obstet Gynecol. 1988; 72: 113-118
- Congenital aortic stenosis and pregnancy – a reappraisal.Am J Obstet Gynecol. 1993; 169: 540-545
- Pregnancy outcomes and cardiac complications in women with mechanical, bioprosthetic and homograft valves.BJOG. 2000; 107: 245-253
- Births Final data for 2007. National vital statistics reports. vol. 58. National Center for Health Statistics, Hyattsville, MD2010
- Pre-eclampsia rates in the United States, 1980–2010: age-period-cohort analysis.BMJ. 2013; 347: f6564
Article info
Publication history
Published online: November 24, 2015
Accepted:
October 28,
2015
Received in revised form:
October 21,
2015
Received:
July 1,
2015
Identification
Copyright
© 2015 Elsevier Ireland Ltd. Published by Elsevier Inc. All rights reserved.
