合并二尖瓣狭窄孕妇临床治疗及预后分析

Treatment and prognosis in pregnant women with mitral stenosis

目的 分析合并二尖瓣狭窄孕妇的个体化治疗方案及母婴结局。方法 回顾性分析2008年1月至2014年10月于首都医科大学附属北京安贞医院收治的12例合并二尖瓣狭窄孕妇的临床资料，包括一般临床资料、个体化治疗方案及母婴结局情况。结果 12例合并二尖瓣狭窄孕妇中二尖瓣重度狭窄8例，二尖瓣中度狭窄2例，二尖瓣瓣叶变形、轻度狭窄并关闭不全1例，二尖瓣狭窄换瓣术后卡瓣1例。9例行经皮二尖瓣球囊扩张术；4例在体外循环下行相应的心脏手术，包括第9例患者行介入性球囊扩张术十二尖瓣和主动脉瓣生物瓣换瓣术＋剖宫产术，第10例患者行二尖瓣、主动脉瓣置换术＋赘生物清除术＋剖宫取胎术，第11例患者行二尖瓣成形＋赘生物清除术＋剖宫产术，第12例患者行二次二尖瓣置换术＋赘生物清除术＋剖宫产术。 2例经皮二尖瓣球囊扩张术后的孕妇足月后自然分娩，9例剖宫产术（4例足月后剖宫产，5例因心脏情况及时终止妊娠），第10例孕妇因心力衰竭孕中期行剖宫取胎术。第11例孕妇经积极治疗存活,第12例孕妇因产后多脏器衰竭于产后30 d死亡。足月儿6例存活;早产儿5例，其中4例存活，1例死亡（第12例）；第10例孕中期剖宫取胎为死胎。随访3～9年，存活10例新生儿发育良好。结论 根据合并二尖瓣狭窄孕妇情况,多学科协作制定孕产妇个体化治疗方案，可降低孕产妇死亡率，挽救母婴生命。

Objective To analyze individualized treatment plans and maternal-infant outcomes in pregnancy women with mitral stenosis. Methods Clinical data of 12 pregnant women complicated with mitral stenosis from January 2008 to October 2014 in Beijing Anzhen Hospital, Capital Medical University were retrospectively analyzed. General clinical information, individualized treatment plans and outcomes of mother and baby were analyzed. Results There were 8 cases of severe mitral stenosis, 2 cases of moderate mitral stenosis, 1 case of mitral valve deformation＋mild stenosis and regurgitation and 1 case of incompetence after mitral valve replacement. Nine patients had percutaneous balloon mitral valvuloplasty; 4 patients had cardiac surgeries with cardiopulmonary bypass（perautaneous ballon mitral valvuloplusty＋mitral and aortic valve replacement＋cesarean section, mitral and aortic valve replacement＋neoplasm excision＋abortion section, mitral valvuloplasty＋neoplasm excision＋cesavean section, re-mitral valve replacement＋neoplasm excision＋cesarean section. Two patients had full-term delivery after percutaneous balloon mitral valvuloplasty. Nine patients had cesarean section, 4 of them were full-term. Six full-term infants survived; 5 premature infants had 4 survivals. The patient with re-mitral replacement died of multiple organ failure 30 d after delivery. The 10 survived babies were developing well in 3-9 years of follow-up. Conclusion Developing individualized treatment plans helps improve maternal-infant outcomes in pregnancy women with mitral stenosis.