nach oben

Netherlands Heart Journal

Erschienen in:

01.12.2008 | review article

Pregnancy in women with prosthetic heart valves

verfasst von: P. G. Pieper, A. Balci, A. P. Van Dijk

Erschienen in: Netherlands Heart Journal | Ausgabe 12/2008

Einloggen, um Zugang zu erhalten

Abstract

Pregnancy in women with mechanical valve prostheses has a high maternal complication rate including valve thrombosis and death. Coumarin derivatives are relatively safe for the mother with a lower incidence of valve thrombosis than un-fractionated and low-molecular-weight heparin, but carry the risk of embryopathy, which is probably dose-dependent. The different anticoagulation regimens are discussed in this review. When valve thrombosis occurs during pregnancy, thrombolysis is the preferable therapeutic option. Bioprostheses have a more favourable pregnancy outcome than mechanical prostheses but due to the high re-operation rate in young women they do not constitute the ideal alternative. When women with native valve stenosis need pre-pregnancy intervention, mitral balloon valvuloplasty is the best option in mitral stenosis, while the Ross operation or homograft implantation may be the preferable surgical regimen in aortic stenosis. (Neth Heart J 2008;16:406-11.)

Pirani BB, Campbell, DM, MacGillivray I. Plasma volume in normal first pregnancy.J Obstet Gynaecol Br Commonw 1973;80:884-7.

Clark SL, Cotton DB, Lee W, Bishop C, Hill T, Southwick J, et al. Central hemodynamic assessment of normal term pregnancy. Am J Obstet Gynecol 1989;161:1439-42.

Campos O. Doppler Echocardiography During Pregnancy: Physiological and Abnormal Findings. Echocardiography 1996;13:135-46.

Capeless EL, Clapp JF. Cardiovascular changes in early phase of pregnancy. Am J Obstet Gynecol 1989;161:1449-53.

Williams DJ, Vallance PJ, Neild GH, Spencer JA, Imms FJ. Nitric oxide-mediated vasodilation in human pregnancy. Am J Physiol 1997;272:H748-H752.

Davison JM. Kidney function in pregnant women. Am J Kidney Dis 1987;9:248-52.

Toglia MR, Weg JG. Venous thromboembolism during pregnancy. N Engl J Med 1996;335:108-14.

Hall JG. Embryopathy associated with oral anticoagulant therapy. Birth Defects Orig Artic Ser 1976;12:33-7.

van Driel D, Wesseling J, Sauer PJ, Touwen BC, van der Veer E, Heymans HS. Teratogen update: fetal effects after in utero exposure to coumarins overview of cases, follow-up findings, and patho-genesis. Teratology 2002;66:127-40.

10.

Vitale N, De Feo M, De Santo LS, Pollice A, Tedesco N, Cotrufo M. Dose-dependent fetal complications of warfarin in pregnant women with mechanical heart valves. J Am Coll Cardiol 1999;33:1637-41.

11.

Chan WS, Anand S, Ginsberg JS. Anticoagulation of pregnant women with mechanical heart valves: a systematic review of the literature. Arch Intern Med 2000;160:191-6.

12.

Hung L, Rahimtoola SH. Prosthetic heart valves and pregnancy. Circulation 2003;107:1240-6.

13.

Dahlman TC. Osteoporotic fractures and the recurrence of thromboembolism during pregnancy and the puerperium in 184 women undergoing thromboprophylaxis with heparin. Am J Obstet Gynecol 1993;168:1265-70.

14.

Meschengieser SS, Fondevila CG, Santarelli MT, Lazzari MA. Anticoagulation in pregnant women with mechanical heart valve prostheses. Heart 1999;82:23-6.

15.

OranB, Lee-ParritzA, Ansell J. Low molecular weight heparin for the prophylaxis of thromboembolism in women with prosthetic mechanical heart valves during pregnancy. Thromb Haemost 2004;92:747-51.

16.

Elkayam U, Singh H, Irani A, Akhter MW. Anticoagulation in pregnant women with prosthetic heart valves. J Cardiovasc Pharmacol Ther 2004;9:107-15.

17.

Barbour LA, Oja JL, Schultz LK. A prospective trial that demonstrates that dalteparin requirements increase in pregnancy to maintain therapeutic levels of anticoagulation. Am J Obstet Gynecol 2004;191:1024-9.

18.

Turpie AG, Gent M, Laupacis A, Latour Y, Gunstensen J, Basile F, et al. A comparison of aspirin with placebo in patients treated with warfarin after heart-valve replacement. N Engl J Med 1993;329:524-9.

19.

Bonow RO, Carabello BA, Chatterjee K, de Leon A Jr, Faxon DP, Freed MD, et al. ACC/AHA 2006 guidelines for the management of patients with valvular heart disease: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (writing Committee to Revise the 1998 guidelines for the management of patients with valvular heart disease) developed in collaboration with the Society of Cardiovascular Anesthesiologists endorsed by the Society for Cardiovascular Angiography and Interventions and the Society of Thoracic Surgeons. J Am Col Cardiol 2006;48:e1-148.

20.

Vahanian A, Baumgartner H, Bax J, Butchart E, Dion R, Filippatos G, et al. Guidelines on the management of valvular heart disease: The Task Force on the Management of Valvular Heart Disease of the European Society of Cardiology. Eur Heart J 2007;28:230-68.

21.

van Leeuwen Y, Rosendaal FR, van der Meer FJ. The relationship between maintenance dosages of three vitamin K antagonists: Acenocoumarol, warfarin and phenprocoumon. Thromb Res 2008 Apr 11 (Epub ahead of print)

22.

Montorsi P, De Bernardi F, Muratori M, Cavoretto D, Pepi M. Role of cine-fluoroscopy, transthoracic, and transesophageal echo-cardiography in patients with suspected prosthetic heart valve thrombosis. Am J Cardiol 2000;85:58-64.

23.

Lowe SA. Diagnostic radiography in pregnancy: risks and reality. Aust N Z J Obstet Gynaecol 2004;44:191-6.

24.

Lengyel M. Thrombolysis should be regarded as first-line therapy for prosthetic valve thrombosis in the absence of contraindications. J Am Coll Cardiol 2005;45:325.

25.

Caceres-Loriga FM. Prosthetic valve thrombosis: is it time for a new consensus conference? Eur J Echocardiogr 2008;9:413-4.

26.

Weiss BM, von Segesser LK, Alon E, Seifert B, Turina MI. Outcome of cardiovascular surgery and pregnancy: a systematic review of the period 1984-1996. Am J Obstet Gynecol 1998;179:1643-53.

27.

Arnoni RT, Arnoni AS, Bonini RC, de Almeida AF, Neto CA, Dinkhuysen JJ, et al. Risk factors associated with cardiac surgery during pregnancy. Ann Thorac Surg 2003;76:1605-8.

28.

Sahnoun-Trabelsi I, Jimenez M, Choussat A, Roudaut R. [Prosthetic valve thrombosis in pregnancy. A single-center study of 12 cases]. Arch Mal Coeur Vaiss 2004;97:305-10.

29.

Lengyel M, Fuster V, Keltai M, Roudaut R, Schulte HD, Seward JB, et al. Guidelines for management of left-sided prosthetic valve thrombosis: a role for thrombolytic therapy. Consensus Conference on Prosthetic Valve Thrombosis. J Am Coll Cardiol 1997;30:1521-6.

30.

Parry AJ, Westaby S. Cardiopulmonary bypass during pregnancy. Ann Thorac Surg 1996;61:1865-9.

31.

Lesniak-Sobelga A, Tracz W, KostKiewicz M, Podolec P, Pasowicz M. Clinical and echocardiographic assessment of pregnant women with valvular heart diseases—maternal and fetal outcome. Int J Cardiol 2004;94:15-23.

32.

Ruel M, Rubens FD, Masters RG, Pipe AL, Bedard P, Hendry PJ, et al. Late incidence and predictors of persistent or recurrent heart failure in patients with aortic prosthetic valves. J Thorac Cardiovasc Surg 2004;127:149-59.

33.

Lam BK, Chan V, Hendry P, Ruel M, Masters R, Bedard P, et al. The impact of patient-prosthesis mismatch on late outcomes after mitral valve replacement. J Thorac Cardiovasc Surg 2007;133:1464-73.

34.

Belford PM, Davis J, Wells G. A case of prosthesis-patient mismatch complicating pregnancy. Am J Perinatol 2007;24:241-2.

35.

Elkayam U, Bitar F. Valvular heart disease and pregnancy: part II: prosthetic valves. J Am Coll Cardiol 2005;46:403-10.

36.

Sbarouni E, Oakley CM. Outcome of pregnancy in women with valve prostheses. Br Heart J 1994;71:196-201.

37.

Sadler L, McCowan L, White H, Stewart A, Bracken M, North R. Pregnancy outcomes and cardiac complications in women with mechanical, bioprosthetic and homograft valves. BJOG 2000;107:245-53.

38.

North RA, Sadler L, Stewart AW, McCowan LM, Kerr AR, et al. Long-term survival and valve-related complications in young women with cardiac valve replacements. Circulation 1999;99:2669-76.

39.

Lund O, Chandrasekaran V, Grocott-Mason R, Elwidaa H, Mazhar R, Khaghani A, et al. Primary aortic valve replacement with allografts over twenty-five years: valve-related and procedure-related determinants of outcome. J Thorac Cardiovasc Surg 1999;117:77-90.

40.

Dore A, Somerville J. Pregnancy in patients with pulmonary autograft valve replacement. Eur Heart J 1997;18:1659-62.

41.

Yap SC, Drenthen W, Pieper PG, Moons P, Mulder BJ, Klieverik LM, et al. Outcome of pregnancy in women after pulmonary autograft valve replacement for congenital aortic valve disease. J Heart Valve Dis 2007;16:398-403.

42.

Hameed A, Karaalp IS, Tummala PP, Wani OR, Canetti M, Akhter MW, et al. The effect of valvular heart disease on maternal and fetal outcome of pregnancy. J Am Coll Cardiol 2001;37:893-9.

43.

Silversides CK, Colman JM, Sermer M, Siu SC. Cardiac risk in pregnant women with rheumatic mitral stenosis. Am J Cardiol 2003;91:1382-5.

44.

Silversides CK, Colman JM, Sermer M, Farine D, Siu SC. Early and intermediate-term outcomes of pregnancy with congenital aortic stenosis. Am J Cardiol 2003;91:1386-9.

45.

Yap SC, Drenthen W, Pieper PG, Moons P, Mulder BJ, Mostert B, et al. Risk of complications during pregnancy in women with congenital aortic stenosis. Int J Cardiol 2008;126:240-6.

46.

Siu SC, Sermer M, Colman JM, Alvarez AN, Mercier LA, Morton BC, et al. Prospective multicenter study of pregnancy outcomes in women with heart disease. Circulation 2001;104:515-21.

47.

Elkayam U Bitar F. Valvular heart disease and pregnancy part I: native valves. J Am Coll Cardiol 2005;46:223-30.

Titel: Pregnancy in women with prosthetic heart valves
verfasst von: P. G. Pieper
A. Balci
A. P. Van Dijk
Publikationsdatum: 01.12.2008
Verlag: Bohn Stafleu van Loghum
Erschienen in: Netherlands Heart Journal / Ausgabe 12/2008
Print ISSN: 1568-5888
Elektronische ISSN: 1876-6250
DOI: https://doi.org/10.1007/BF03086187

Neu im Fachgebiet Kardiologie

Screening-Mammografie offenbart erhöhtes Herz-Kreislauf-Risiko

26.04.2024 Mammografie Nachrichten

Routinemäßige Mammografien helfen, Brustkrebs frühzeitig zu erkennen. Anhand der Röntgenuntersuchung lassen sich aber auch kardiovaskuläre Risikopatientinnen identifizieren. Als zuverlässiger Anhaltspunkt gilt die Verkalkung der Brustarterien.

Niedriger diastolischer Blutdruck erhöht Risiko für schwere kardiovaskuläre Komplikationen

25.04.2024 Hypotonie Nachrichten

Wenn unter einer medikamentösen Hochdrucktherapie der diastolische Blutdruck in den Keller geht, steigt das Risiko für schwere kardiovaskuläre Ereignisse: Darauf deutet eine Sekundäranalyse der SPRINT-Studie hin.

Therapiestart mit Blutdrucksenkern erhöht Frakturrisiko

25.04.2024 Hypertonie Nachrichten

Beginnen ältere Männer im Pflegeheim eine Antihypertensiva-Therapie, dann ist die Frakturrate in den folgenden 30 Tagen mehr als verdoppelt. Besonders häufig stürzen Demenzkranke und Männer, die erstmals Blutdrucksenker nehmen. Dafür spricht eine Analyse unter US-Veteranen.

Adipositas-Medikament auch gegen Schlafapnoe wirksam

24.04.2024 Adipositas Nachrichten

Der als Antidiabetikum sowie zum Gewichtsmanagement zugelassene Wirkstoff Tirzepatid hat in Studien bei adipösen Patienten auch schlafbezogene Atmungsstörungen deutlich reduziert, informiert der Hersteller in einer Vorab-Meldung zum Studienausgang.

Update Kardiologie

Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert.

Newsletter bestellen

Springer Medizin

Abstract

Bitte loggen Sie sich ein, um Zugang zu diesem Inhalt zu erhalten

Weitere Artikel der Ausgabe 12/2008

A serious complication in the puerperium: peripartum cardiomyopathy

Expected and unexpected cardiac problems during pregnancy

Left ventricular assist device as a bridge to recovery in a young woman admitted with peripartum cardiomyopathy

Bone marrow cell therapy after acute myocardial infarction: the HEBE trial in perspective, first results