ECHO 2013 / Echo Evaluation of Pregnant Patients with Heart Disease
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INCIDENCE OF CONGENITAL HEART DISEASE IN CHILDHOOD AND PREGNANCY
|
Childhood |
Pregnancy |
Ventricular septal defect |
35% |
13% |
Atrial septal defect |
9% |
9% |
Patent ductus arteriosis |
8% |
2.7% |
Pulmonic stenosis |
8% |
8% |
Aortic stenosis |
6% |
20% |
Coarctation of the aorta |
6% |
8% |
Tetralogy of Fallot |
5% |
12% |
Transposition of the great vessels |
4% |
5.4% |
Compiled by Easterling in Gabbe, Obstetrics, 2002 with data from Shime Am J Obstet Gynecol 1987 and Findlow Br J Anaesth 1997
INCIDENCE OF CONGENITAL HEART DISEASE IN CHILDHOOD AND PREGNANCY
|
Childhood |
Pregnancy |
Ventricular septal defect |
35% |
13% |
Atrial septal defect |
9% |
9% |
Patent ductus arteriosis |
8% |
2.7% |
Pulmonic stenosis |
8% |
8% |
Aortic stenosis |
6% |
20% |
Coarctation of the aorta |
6% |
8% |
Tetralogy of Fallot |
5% |
12% |
Transposition of the great vessels |
4% |
5.4% |
Compiled by Easterling in Gabbe, Obstetrics, 2002 with data from Shime Am J Obstet Gynecol 1987 and Findlow Br J Anaesth 1997
SPECIFIC LESIONS
CONGENITAL AORTIC STENOSIS
49 pregnancies, 39 women, mean follow-up 3.7 years
50%
40%
30%
20%
10%
0%
Cardiac complications during |
Cardiac surgery during follow-up |
pregnancy |
|
Mild or moderate AS |
Severe AS |
Silversides Am J Cardiol 2003
MITRAL STENOSIS
74 women, 80 pregnancies
89% NYHA 1 11% NYHA 2
MATERNAL EVENTS PULMONARY EDEMA ARRHYTHMIA
FETAL EVENTS
PREMATURE
SMALL FOR
GESTATIONAL AGE
78%
67%
44%
40%
26%
21%
Silversides et al Am J Cardiol 2003
MARFAN SYNDROME
Women
Pregnancies
Live births
Miscarriages
Terminations
Fetal deaths
Aortic events
Dissection Rapid dilation
84
241
181 (75%)
38 (16%)
17 (7%)
2 (0.8%)
8 (4.3%)
6 (3.3%)
2 (1.1%)
Death |
2 (1.1%) |
All aortic events and deaths occurred with aortic roots >4 cm
Compiled by Easterling and Stout in Gabbe, Obstetrics, 2007 with data from Lipscomb, Br J Obstet Gynecol 1997 , Pyeritz Am J Med 1981, Rossiter Am J Obstet Gynecol 1995
PERIPARTUM CARDIOMYOPATHY
44 women, 35 completed pregnancies
Elkayam et al NEJM 2001
ECHOCARDIOGRAPHIC EVALUATION
KEY CONCERNS
LESION & IMPACT
KEY CONCERNS
LESION & IMPACT
“PRIMARY’ OTHER ABNORMALITY COEXISTANT
LESIONS