Qiangqiang Li1, Konstantinos Dimopoulos2, Tianyang Liu3, Zhuoyuan Xu1, Qian Liu1, Yanna Li4, Jun Zhang4, Hong Gu1. 1. 1 Department of Pediatric Cardiology, Beijing Anzhen Hospital, Capital Medical University, China. 2. 2 Adult Congenital Heart Centre and Centre for Pulmonary Hypertension, Royal Brompton Hospital and Imperial College, UK. 3. 3 Hospital Manager Office, Beijing Anzhen Hospital, China. 4. 4 Obstetrics and Gynecology, Beijing Anzhen Hospital, Capital Medical University, China.
Abstract
AIMS: Pulmonary arterial hypertension is a severe complication in patients with congenital heart disease and poses a significant risk to women wishing to become pregnant. This study describes the clinical presentation, maternal outcomes and risk factors for the peripartum period in women with pulmonary arterial hypertension related to congenital heart disease (PAH-CHD). METHODS: All pregnant women with PAH-CHD who were admitted for delivery in a tertiary center between February 2011-September 2016 were included. Logistic regression analysis was used to identify predictors of the combined endpoint of maternal death, severe heart failure requiring treatment, or pulmonary hypertensive crisis. RESULTS: Ninety-three women (94 pregnancies) were included. Average age was 27.5 ± 4.4 years. Thirty (31.9%) patients had Eisenmenger syndrome, 51 (54.3%) had pulmonary arterial hypertension associated with systemic-to-pulmonary shunts, and 13 (13.8%) had pulmonary arterial hypertension with corrected congenital heart disease. Twenty-three (24.5%) women required admission for delivery within two days from presentation. Elective Cesarean section was performed in 95.7% of women, with intravertebral anesthesia in 93.6%. Fifty-one (54.2%) patients received pulmonary arterial hypertension therapies during pregnancy. Six (6.4%) women died, 33 (35.1%) developed heart failure and 10 (10.6%) had a pulmonary hypertensive crisis. Patients who met the combined endpoint (n = 34, 36.2%) were more likely to have Eisenmenger syndrome or repaired defects (p < 0.001). Other risk factors in the multivariate model included lower arterial blood oxygen saturation, higher brain natriuretic peptide, and pericardial effusion on echocardiography. CONCLUSION: Maternal mortality and morbidity remain high in PAH-CHD patients, who should be counseled on the risks of pregnancy and managed in a tertiary multidisciplinary environment to improve prognosis.
AIMS: Pulmonary arterial hypertension is a severe complication in patients with congenital heart disease and poses a significant risk to women wishing to become pregnant. This study describes the clinical presentation, maternal outcomes and risk factors for the peripartum period in women with pulmonary arterial hypertension related to congenital heart disease (PAH-CHD). METHODS: All pregnant women with PAH-CHD who were admitted for delivery in a tertiary center between February 2011-September 2016 were included. Logistic regression analysis was used to identify predictors of the combined endpoint of maternal death, severe heart failure requiring treatment, or pulmonary hypertensive crisis. RESULTS: Ninety-three women (94 pregnancies) were included. Average age was 27.5 ± 4.4 years. Thirty (31.9%) patients had Eisenmenger syndrome, 51 (54.3%) had pulmonary arterial hypertension associated with systemic-to-pulmonary shunts, and 13 (13.8%) had pulmonary arterial hypertension with corrected congenital heart disease. Twenty-three (24.5%) women required admission for delivery within two days from presentation. Elective Cesarean section was performed in 95.7% of women, with intravertebral anesthesia in 93.6%. Fifty-one (54.2%) patients received pulmonary arterial hypertension therapies during pregnancy. Six (6.4%) women died, 33 (35.1%) developed heart failure and 10 (10.6%) had a pulmonary hypertensive crisis. Patients who met the combined endpoint (n = 34, 36.2%) were more likely to have Eisenmenger syndrome or repaired defects (p < 0.001). Other risk factors in the multivariate model included lower arterial blood oxygen saturation, higher brain natriuretic peptide, and pericardial effusion on echocardiography. CONCLUSION: Maternal mortality and morbidity remain high in PAH-CHDpatients, who should be counseled on the risks of pregnancy and managed in a tertiary multidisciplinary environment to improve prognosis.
Authors: Zhuoyuan Xu; Michael A Gatzoulis; Konstantinos Dimopoulos; Qiangqiang Li; Chen Zhang; Bradley B Keller; Hong Gu Journal: CJC Open Date: 2021-02-17
Authors: Yang Liu; Yanna Li; Jun Zhang; Wenjuan Zhao; Zhaoliang Bao; Xiaolong Ma; Yichen Zhao; Cheng Zhao; Kemin Liu; Qing Ye; Lixiao Su; Yao Yang; Jing Yang; Gang Li; Xiangming Fan; Jiangang Wang Journal: Front Cardiovasc Med Date: 2022-01-21