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Location matters: left heart obstruction in pregnancy
Margaret Fuchs1, Ali N Zaidi2, Justin Rose1
1The Ohio State University Department of Internal Medicine, Division of Cardiovascular Medicine, and Nationwide Children's Hospital Heart Center, Columbus, OH, United States.
European Journal of Obstetrics, Gynecology, and Reproductive Biology
|December 15, 2015
Summary
Pregnant women with left heart obstruction face risks, particularly those with isolated mitral stenosis or multiple obstructive lesions. Early identification and specialized care are crucial for managing these complex pregnancies.
Area of Science:
- Cardiology
- Obstetrics
- Maternal-Fetal Medicine
Background:
- Left heart obstruction in pregnancy is linked to increased maternal and fetal complications.
- Understanding specific risks associated with different types of left heart obstruction is essential for optimal management.
Purpose of the Study:
- To evaluate maternal cardiovascular, obstetric, and fetal/infant outcomes in pregnant women with left heart obstruction.
- To identify specific left heart obstructive lesions associated with higher event rates.
Main Methods:
- Retrospective analysis of pregnant women with current or repaired left heart obstruction (2000-2014).
- Inclusion criteria: mitral stenosis, left ventricular outflow tract obstruction, and coarctation of the aorta.
- Maternal cardiovascular events included heart failure, arrhythmia, cardiac surgery/intervention, stroke, and death.
Main Results:
- Isolated mitral stenosis and multiple serial left heart obstructive lesions were associated with the majority of maternal cardiovascular events.
- Women with isolated mitral stenosis had significantly higher cardiovascular event rates compared to other single lesions (OR 18.6).
- Higher New York Heart Association class, current obstruction, severe obstruction, and higher CARPREG scores predicted events; term birth weight was lower in those with events.
Conclusions:
- Isolated mitral stenosis and serial left heart obstructive lesions pose the highest risk for maternal cardiovascular events during pregnancy.
- This study is the first to report higher event rates in women with serial left heart obstructive lesions.
- Specialized high-risk obstetric-cardiac teams are recommended for managing pregnant women with left heart obstruction, demonstrating excellent outcomes in this complex cohort.
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