青年女性患者心脏瓣膜的选择

Choice of Heart Valve in Young Female Patients

心脏瓣膜置换术后的青年女性患者在围产期有较高的母婴不良事件发生率,其中机械瓣膜置换术后母婴不良事件的发生率更高,主要与抗凝治疗和机械瓣膜本身易致血栓形成特性有关。由于生物瓣膜衰败,其长期耐久性有限,生物瓣膜置换术后青年女性将可能面临再次手术,因此在这些青年女性中选择生物瓣膜存在争议。现围绕机械瓣膜术后孕妇抗凝治疗、围产期的各种不良事件、新型瓣膜、新型换瓣技术等方面做一综述,为有生育需求的青年女性患者在瓣膜选择方面提供理论基础。

Young female with prosthetic heart valves are associated with an increased risk of maternal or fetal/neonatal adverse events during perinatal period,particularly pregnant women with mechanical valves are associated with a higher risk of adverse events,primarily due to anticoagulant therapy and the inherent thrombogenic nature of mechanical valves.Young female with bioprosthetic valves will face reoperation due to bioprosthetic valve deterioration and its limited long-term durability,the choice for bioprosthetic heart valves in these young female is not indisputable.In this article,we reviewed the anticoagulant management for pregnant women after mechanical valve replacement,various adverse events during pregnancy,new generation prosthetic valves,and new valve replacement techniques,which provides a theoretical basis for the choice of valve replacement for young female with pregnancy wish.