复杂先天性心脏病孕产妇围产期管理的探讨

Management of pregnancy in patients with complicated congenital heart disease:3 case reports and literature review

目的:探讨先天性心脏病(先心病)孕产妇的管理。方法:分析3例未矫正的复杂先心病孕产妇的临床资料并复习文献。结果:患者年龄分别为24岁、26岁和28岁。孕龄6+w、36+w和34+w。其中单心房2例,合并有中/重度肺动脉高压,单心室并单心房1例,均无心脏畸形矫正术史。手术方式:人工流产1例,剖宫产2例。无孕产妇及胎儿死亡。2例过渡型房室间隔缺损伴单心房患者无并发症发生;1例单心室并单心房等多发心血管畸形患者孕晚期出现妊高症和心功能不全,产后出现室上性心律失常、腔静脉-心房部位附壁血栓、急性心肌梗死。结论:复杂先心病患者有较高的围产期心血管风险,能否妊娠应婚前咨询,一旦妊娠应及早终止妊娠,围产期需多学科参与的监护和治疗,提倡依据严密监测结果指导下的临床处理,减少并发症发生率,保证母婴安全。

Objective：To discuss the management of pregnant patients with congenital heart disease.Methods：To report the clinical profiles of 3 pregnant patients with uncorrected complicated congenital heart disease and literature review.Results：Patients＇ ages were 24,26 and 28 years.Gestational ages were 6 ＋weeks,36 ＋ weeks and 34 ＋ weeks,respectively.Among them,2 had single atrium accompanied by moderate-to-severe pulmonary hypertension and 1 had single atrium and ventricle.There was no history of heart defect correction in any of the 3 patients.In the 3 cases,1 patient underwent induced abortion and 2 received cesarean sections.All 3 women and the late gestation infants survived.The 2 single atrium patients with transitional atrioventricular septal defect had no complications.The single atrium and single ventricle patient with multiple cardiovascular abnormalities experienced pregnancy-induced hypertension syndrome and cardiac insufficiency during late pregnancy,with supraventricular arrhythmia,a parietal thrombus of the vena cava and atrium and acute myocardial infarction during the postpartum period.Conclusion：Pregnant patients with complicated congenital heart disease have a high risk of cardiovascular complications.They should consult their pregnancy capability before marriage.Once the patients are pregnant,early termination of pregnancy is suggested.Monitoring and treatment from a multidisciplinary team during perinatal period are required and strict surveillance guided clinical treatment is suggested to reduce complications and ensure the safety of mother and infant.