Am J Perinatol 2001; 18(5): 245-266
DOI: 10.1055/s-2001-16991
ORIGINAL ARTICLES

Copyright © 2001 by Thieme Medical Publishers, Inc., 333 Seventh Avenue, New York, NY 10001, USA. Tel.: +1(212) 584-4662

Cardiac Disease in Pregnancy

Patrick S. Ramsey1 , Kirk D. Ramin2 , Susan M. Ramin3
  • 1Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of Alabama at Birmingham, Birmingham, Alabama
  • 2Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Mayo Medical Center, Rochester, Minnesota
  • 3Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of Texas-Houston Medical School, Houston Texas
Weitere Informationen

Publikationsverlauf

Publikationsdatum:
10. September 2001 (online)

ABSTRACT

Cardiovascular adaptations of pregnancy are generally well tolerated in the healthy gravida; however, these changes can place undue stress on women with underlying cardiovascular disease and can result in increased risk for morbidity and mortality. In this article, we will review issues related to preconceptional counseling, cardiovascular adaptations of pregnancy, and the prognosis and management of the gravida with cardiac disease in pregnancy.

REFERENCES

  • 1 McFaul P B, Dornan J C, Lamki H, Boyle D. Pregnancy complicated by maternal heart disease: a review of 519 women.  Br J Obstet Gynaecol . 1988;  95 861-867
  • 2 Wooley C F, Sparks E H. Congenital heart disease, heritable cardiovascular disease and pregnancy.  Progr Cardiovasc Dis . 1992;  35 41-60
  • 3 Metcalfe J, McAnulty J H, Ueland K. Cardiovascular physiology.  Clin Obstet Gynecol . 1981;  24 693-710
  • 4 Metcalfe J, Ueland K. Maternal cardiovascular adjustments to pregnancy.  Progr Cardiovasc Dis . 1974;  16 363-374
  • 5 Clark S L, Cotton D B, Hankins G DV, Phelan J P. Cardiac disease.  In: Critical Care Obstetrics. 3rd ed. Malden, MA: Blackwell Science 1997: 290-313
  • 6 Greiss F C, Anderson S G. Effect of ovarian hormones on the uterine vasculature bed.  Am J Obstet Gynecol . 1970;  23 765-768
  • 7 Bryant E E, Douglas B H, Ashburn A D. Circulatory changes following prolactin administration.  Am J Obstet Gynecol . 1973;  115 53-57
  • 8 Gerber J G, Payne N A, Murphy R C, Nies A S. Prostacyclin produced by the pregnant uterus in the dog may act as a circulating vasodepressor substance.  J Clin Invest . 1981;  67 632-636
  • 9 Soares De Maura R. Effect of prostacyclin on the perfusion pressure and the vasoconstrictor response of angiotensin II in the human isolated foetal placental circulation.  Br J Clin Pharmacol . 1987;  23 765-768
  • 10 Carruth J E, Mivis S B, Brogan D R, Wenger N K. The electrocardiogram in normal pregnancy.  Am Heart J . 1981;  102 1075-1078
  • 11 Upshaw C B. A study of maternal electrocardiograms recorded during labor and delivery.  Am J Obstet Gynecol . 1970;  107 17-27
  • 12 Kerr M G. Cardiovascular dynamics in pregnancy and labor.  Br Med Bull . 1968;  24 19-24
  • 13 Robson S C, Dunlop W, Boys R J, Hunter S. Cardiac output during labor.  Br Med J . 1987;  295 1169-1172
  • 14 Kjeldsen J. Hemodynamic investigations during labor and delivery.  Acta Obstet Gynecol Scand Suppl . 1979;  89 1-252
  • 15 Criteria Committee of the New York Heart Association. Nomenclature and Criteria for Diagnosis of Diseases of the Heart and Great Vessels 8th ed. Boston: Little Brown; 1979
  • 16 Nora J J, Nora A H. Genetics and Counseling in Cardiovascular Disease.  Springfield, IL: Charles Thomas; 1978
  • 17 Nora J J, Nora A H. Maternal transmission of congenital heart disease: new recurrence risk figures and the questions of cytoplasmic inheritance and vulnerability to teratogens.  Am J Cardiol . 1987;  59 459-463
  • 18 Pilu G, Baccarani G, Perolo A, Picchio F M, Bovicelli L. Prenatal diagnosis of congenital heart disease. In: Fleischer AC, Manning FA, Jeanty P, Romero R, eds. Sonography in Obstetrics and Gynecology: Principles and Practice 5th ed. Stamford, CT: Appleton & Lange 1996: 149-172
  • 19 American College of Obstetricians and Gynecologists. Cardiac disease in pregnancy.  ACOG Technical Bull . 1992;  168 1-8
  • 20 Clark S L. Labor and delivery in the patient with structural cardiac disease.  Clin Perinatol . 1986;  13 695-703
  • 21 Szekely P, Turner R, Snaith L. Pregnancy and the changing pattern of rheumatic heart disease.  Br Heart J . 1973;  35 1293-1303
  • 22 Romero R, Pilu G, Jeanty P, Ghidini A, Hobbins. Approaches to the Examination of the Fetal Heart.  In: Prenatal Diagnosis of Congenital Anomalies. Norwalk, CT: Appleton & Lange; 1988
  • 23 Paladini D, Calabro R, Palmieri S, D'Andrea T. Prenatal diagnosis of congenital heart disease and fetal karyotyping.  Obstet Gynecol . 1993;  81 679-682
  • 24 Copel J A, Cullen M, Green J J, Mahoney M J, Hobbins J C, Kleinman C S. The frequency of aneuploidy in prenatally diagnosed congenital heart disease: an indication for fetal karyotyping.  Am J Obstet Gynecol . 1988;  158 409-413
  • 25 Whittemore R, Hobbins J C, Eagle M A. Pregnancy and its outcome in women with and without surgical treatment of congenital heart disease.  Am J Cardiol . 1982;  50 641-651
  • 26 Mortenson J D, Ellsworth H S. Pregnancy before and after surgical correction of left-to-right cardiovascular shunts.  Obstet Gynecol . 1967;  29 241-243
  • 27 Clark S L, Phelan J P, Greenspoon J, Aldahl D, Horenstein J. Labor and delivery in the presence of mitral stenosis: central hemodynamic observations.  Am J Obstet Gynecol . 1985;  152 984-988
  • 28 Szekely P, Julian D G. Heart disease and pregnancy.  Curr Probl Cardiol . 1979;  4 1-74
  • 29 Ducey J P, Ellsworth S M. The hemodynamic effects of severe mitral stenosis and pulmonary hypertension during labor and delivery.  Intensive Care Med . 1989;  15 192-195
  • 30 Markiewicz W, Stoner J, London E, Hunt S A, Popp R L. Mitral valve prolapse in one hundred previously healthy young females.  Circulation . 1976;  53 464-473
  • 31 Tank L CH, Chan S YW, Wong V CM. Pregnancy in patients with mitral valve prolapse.  Int J Gynecol Obstet . 1985;  23 217-221
  • 32 Haas J M. The effect of pregnancy on the midsystolic click and murmur of the prolapsing posterior leaflet of the mitral valve.  Am Heart J . 1976;  92 407-408
  • 33 Rayburn W F, Fontana M E. Mitral valve prolapse and pregnancy.  Am J Obstet Gynecol . 1981;  141 9-11
  • 34 Dajani A S, Taubert K A, Wilson W. Prevention of bacterial endocarditis: recommendations by the American Heart Association.  JAMA . 1997;  277 1794-1801
  • 35 Barash P G, Hobbins J C, Hook R. Management of coarctation of the aorta during pregnancy.  J Thorac Cardiovasc Surg . 1975;  69 781-784
  • 36 Deal K, Wooley C F. Coarctation of the aorta and pregnancy.  Ann Intern Med . 1973;  78 706-710
  • 37 Ramin S M, Maberry M C, Gilstrap L C. Congenital heart disease.  Clin Obstet Gynecol . 1989;  32 41-47
  • 38 Mendelson C L. Pregnancy and coarctation of the aorta.  Am J Obstet Gynecol . 1940;  39 1014-1021
  • 39 Goodwin J F. Pregnancy and coarctation of the aorta.  Clin Obstet Gynecol . 1961;  4 645
  • 40 Homans D C. Peripartum cardiomyopathy.  N Engl J Med . 1985;  312 1432-1436
  • 41 Veille J C. Peripartum cardiomyopathies: a review.  Am J Obstet Gynecol . 1984;  148 805-818
  • 42 Pearson G D, Veille J C, Hsia J. Peripartum cardiomyopathy: National Heart, Lung and Blood Institute and Office of Rare Diseases (National Institutes of Health) Workshop Recommendations and Review.  JAMA . 2000;  283 1183-1188
  • 43 Demakis J G, Rahimtoala S H, Sutton. Natural course of peripartum cardiomyopathy.  Circulation . 1971;  44 1053-1061
  • 44 Demakis J G, Rahimtoala S H. Peripartum cardiomyopathy.  Circulation . 1971;  44 964-968
  • 45 Walsh J J, Burch G E. Postpartal heart disease.  Arch Intern Med . 1961;  108 817-822
  • 46 Cunningham F G, Pritchard J A, Hankins G VD, Anderson P L, Lucas M J, Armstrong K F. Peripartum heart failure: idiopathic cardiomyopathy or compounding cardiovascular events?.  Obstet Gynecol . 1986;  67 157-167
  • 47 Lang R M, Lampert M B, Poppas A, Hameed A, Elkayam U. Peripartal cardiomyopathy. In: Elkayam U, Gleicher N, eds. Cardiac Problems in Pregnancy 3rd ed. New York: Wiley-Liss 1998: 87-100
  • 48 Melvin K R, Richardson P J, Olsen E G, Daly K, Jackson G. Peripartum cardiomyopathy due to myocarditis.  N Engl J Med . 1982;  307 731-734
  • 49 Felker G M, Thompson R E, Hare J M. Underlying causes and long-term survival in patients with initially unexplained cardiomyopathy.  N Engl J Med . 2000;  342 1077-1084
  • 50 Sutton M S, Cole P, Plappert M, Saltzman D, Goldhaber S. Effects of subsequent pregnancy on left ventricular function in peripartum cardiomyopathy.  Am Heart J . 1991;  121 1776-1778
  • 51 Lampert M, Weinert L, Hibbard J, Korcarz C, Lindheimer M, Lang R M. Contractile reserve in patients with peripartum cardiomyopathy and recovered left ventricular function.  Am J Obstet Gynecol . 1997;  176 189-195
  • 52 Witlin A G, Mabie W C, Sibai B M. Peripartum cardiomyopathy: an ominous diagnosis.  Am J Obstet Gyencol . 1997;  176 182-188
  • 53 Easterling T R, Chadwick H S, Otto C M, Benedetti T J. Aortic stenosis in pregnancy.  Obstet Gynecol . 1988;  72 113-118
  • 54 Arias F, Pinedo J. Aortic stenosis and pregnancy.  J Reprod Med . 1978;  20 229-232
  • 55 Angel J L, Chapman C, Knappel R A, Morales W J, Sims C J. Percutaneous balloon aortic valvuloplasty in pregnancy.  Obstet Gynecol . 1988;  72 438-440
  • 56 Sullivan J M, Ramanathan K B. Management of medical problems in pregnancy: severe cardiac disease.  N Engl J Med . 1985;  313 304-309
  • 57 Landon M. Cardiac and pulmonary disease. In: Gabbe SG, Niebyl JR, Simpson JL Obstetrics: Normal & Problem Pregnancies. 3rd ed. New York: Churchill Livingston 1996: 997-1013
  • 58 Neilson G, Galea E G, Blunt A. Congenital heart disease and pregnancy.  Med J Aust . 1970;  1 1086-1088
  • 58a Mendelson C L. Congenital heart disease. In: Cardiac Disease in Pregnancy: Medical Care, Cardiovascular Surgery, and Obstetric Management as Related to Maternal and Fetal Welfare Philadelphia: FA Davis 1960: 122-175
  • 59 Schaefer G, Arditi L I, Solomon H A, Ringland J E. Congenital heart disease and pregnancy.  Clin Obstet Gynecol . 1968;  11 1048-1063
  • 60 Bjornsson J, Edwards W D. Primary pulmonary hypertension: a histopathologic study of 80 cases.  Mayo Clin Proc . 1985;  60 16-25
  • 61 Fuster V, Steele P M, Edwards W D, Gersh B J, McGoon M D, Frye R L. Primary pulmonary hypertension: natural history and the importance of thrombosis.  Circulation . 1984;  70 580-587
  • 62 Weiss B M, Zemp L, Seifert B, Hess O. Outcome of pulmonary vascular disease in pregnancy: a systematic overview from 1978 through 1996.  J Am Coll Casdiol . 1998;  31 1650-1657
  • 63 Smedstad K G, Cramb R, Morison D H. Pulmonary hypertension and pregnancy: a series of eight cases.  Can J Anaesth . 1994;  41 502-512
  • 64 Tahir H. Pulmonary hypertension, cardiac disease and pregnancy.  Int J Gynecol Obstet . 1995;  51 109-113
  • 65 Dankins K D, Burke C M, Billingham M E, Jamieson S W. Primary pulmonary hypertension and pregnancy.  Chest . 1986;  89 383-388
  • 66 Kleiger R E, Boxer M, Ingham R E, Harrison D C. Pulmonary hypertension in patients using oral contraceptives: a report of six cases.  Chest . 1979;  69 143-147
  • 67 Rich S, Dantzker D R, Ayres S M. Primary pulmonary hypertension: a national prospective study.  Ann Intern Med . 1987;  107 216-223
  • 68 Sinnenberg Jr J R. Pulmonary hypertension in pregnancy.  South Med J . 1980;  73 1529-1531
  • 69 Midwall J, Jaffin H, Herman M V, Kupersmith J. Shunt flow and pulmonary hemodynamics during labor and delivery in the Eisenmenger's syndrome.  Am J Cardiol . 1978;  42 299-303
  • 70 McCaffrey R M, Dunn L J. Primary pulmonary hypertension in pregnancy.  Obstet Gynecol Surv . 1964;  19 567-591
  • 71 Nelson D M, Main E, Crafford W, Ahumado G G. Peripartum heart failure due to primary pulmonary hypertension.  Obstet Gynecol . 1983;  62 595-635
  • 72 Rich S, Kaufmann E, Levy P S. The effect of high doses of calcium-channel blockers on survival in primary pulmonary hypertension.  N Engl J Med . 1992;  327 76-81
  • 73 Rubin L J, Mendoza J, Hood M. Treatment of primary pulmonary hypertension with continuous intravenous prostacyclin.  Ann Int Med . 1990;  112 485-491
  • 74 Barst R J, Rubin L J, Long W A, for the Primary Pulmonary Hypertension Study Group. A comparison of continuous intravenous epoprostenol (Prostacyclin) with conventional therapy for primary pulmonary hypertension.  N Engl J Med . 1996;  334 296-301
  • 75 Hoeper M M, Schwarze M, Ehlerding S. Long-term treatment of primary pulmonary hypertension with aerosolized iloprost, a prostacyclin analogue.  N Engl J Med . 2000;  342 1866-1870
  • 76 Easterling T R, Ralph D D, Schmucker B C. Pulmonary hypertension in pregnancy: treatment with pulmonary vasodilators.  Obstet Gynecol . 1999;  93 494-498
  • 77 Lust K M, Boots R J, Dooris M, Wilson J. Management of labor in Eisenmenger syndrome with inhaled nitric oxide.  Am J Obstet Gynecol . 1999;  181 419-423
  • 78 Goodwin T M, Gherman R B, Hameed A, Elkayam U. Favorable response of Eisenmenger syndrome to inhaled nitric oxide during pregnancy.  Am J Obstet Gynecol . 1999;  180 64-67
  • 79 Gleicher N, Midwell J, Hochberger D, Jaffin H. Eisenmenger's syndrome and pregnancy.  Obstet Gynecol Surv . 1979;  34 721-741
  • 80 Lieber S, Dewilde P H, Huyghens L, Traey E, Gepts E. Eisenmenger's syndrome and pregnancy.  Acta Cardiol . 1986;  40 421-424
  • 81 Yentis S M, Steer P J, Plaat F. Eisenmenger's syndrome in pregnancy: maternal and fetal mortality in the 1990's.  Br J Obstet Gynaecol . 1988;  105 921-922
  • 82 Pitts J A, Crosby W M, Basta L L. Eisenmenger's syndrome in pregnancy; does heparin prophylaxis improve the maternal mortality rate?.  Am Heart J . 1977;  93 321-326
  • 83 Patton D E, Lee W, Cotton D B. Cyanotic maternal heart disease in pregnancy.  Obstet Gynecol Surv . 1990;  45 594-600
  • 84 Presbitero P, Somerville J, Stone S, Aruta E, Spiegelhalter D, Rabajoli F. Pregnancy in cyanotic congenital heart disease: outcome of mother and fetus.  Circulation . 1994;  89 2673-2676
  • 85 Shime J, Mocarski E JM, Hastings D, Webb G D, McLaughin P R. Congenital heart disease in pregnancy: short and long-term implications.  Am J Obstet Gynecol . 1987;  156 313-322
  • 86 Mabie W C, Freire C M. Sudden chest pain and cardiac emergencies in the obstetric patient.  Obstet Gynecol Clin North Am . 1995;  22 19-37
  • 87 Raymond R, Lynch J, Underwood D, Leatherman J, Razavi M. Myocardial infarction and normal coronary arteriography: a 10 year clinical and risk analysis of 74 patients.  J Am Coll Cardiol . 1988;  11 471-477
  • 88 Roth A, Elkayam U. Acute myocardial infarction associated with pregnancy.  Ann Intern Med . 1996;  125 751-762
  • 89 Lee T H, Goldman L. Evaluation of the patient with acute chest pain.  N Engl J Med . 2000;  342 1187-1195
  • 90 Shivvers S A, Wians Jr H F, Keffer J H, Ramin S M. Maternal cardiac troponin I levels during normal labor and delivery.  Am J Obstet Gynecol . 1999;  180 122
  • 91 Hankins G DV, Wendel Jr D G, Leveno K J, Stoneham J. Myocardial infarction during pregnancy: a review.  Obstet Gynecol . 1985;  65 139-146
  • 92 Brown C EL, Wendel G D. Cardiac arrythmias during pregnancy.  Clin Obstet Gynecol . 1989;  32 89-102
  • 93 Schroeder J S, Harrison D C. Repeated cardioversion during pregnancy: treatment of refractory paroxysmal atrial tachycardia during 3 successive pregnancies.  Am J Cardiol . 1971;  27 445-446
  • 94 Rotmensch H H, Rotmensch S, Elkayam U. Management of cardiac dysrhythmia during pregnancy: current concepts.  Drugs . 1987;  33 623-633
  • 95 Jaffe R, Gruber A, Fejgin M. Pregnancy with an artificial pacemaker.  Obstet Gynecol Surv . 1987;  42 137-139
  • 96 Sbarouni E, Oakley C M. Outcome of pregnancy in women with valve prostheses.  Br Heart J . 1994;  71 196-201
  • 97 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;  107 245-253
  • 98 Ginsberg J S, Kowalchuk G, Hirsh J. Heparin therapy during pregnancy: risks to the fetus and mother.  Arch Intern Med . 1989;  149 2233-2236
  • 99 Ramin S M, Ramin K D, Gilstrap L C. Anticoagulation and thrombolytics during pregnancy.  Semin Perinatol . 1997;  21 149-153
  • 100 Hall J G, Pauli R M, Wilson K M. Maternal and fetal sequelae of anticoagulation during pregnancy.  Am J Med . 1980;  68 122-140
  • 101 Stevenson R E, Burton M, Ferlauto G J, Taylor H A. Hazards of oral anticoagulants during pregnancy.  JAMA . 1980;  243 1549-1551
  • 102 Oakley C, Doherty P. Pregnancy in patients after valve replacement.  Br Heart J . 1976;  38 1140-1148
  • 103 Anutes M J, Myer I G, Santos L P. Thrombosis of mitral valve prosthesis in pregnancy: management by simultaneous cesarean section and mitral valve replacement-case report.  Br J Obstet Gynaecol . 1984;  91 716-718
  • 104 Salazar E, Zajarias A, Gutiarraz N, Iturbe I. The problem of cardiac valve prostheses: anticoagulants and pregnancy.  Circulation . 1984;  70 169-177
  • 105 Iturbe-Alessio I, Fonseca M DC, Mutchinick O, Santos M A, Zajarias A, Salazar E. Risks of anticoagulant therapy in pregnant women with artificial valves.  N Engl J Med . 1986;  27 1390-1393
  • 106 Salazar E, Izaguirre R, Verdejo J, Mutchinick O. Failure of adjusted doses of subcutaneous heparin to prevent thromboembolic phenomena in pregnant patients with mechanical cardiac valve protheses.  J Am Coll Cardiol . 1996;  27 1698-1703
  • 107 Dalen E, Hirsh J. American College of Chest Physicians and the National Heart, Lung, and Blood Institute National Conference on Antithrombotic Therapy.  Chest . 1986;  89 1S-106S
  • 108 Bortolloti U, Milano A, Mazzucco A. Pregnancy in patients with a porcine valve prosthesis.  Am J Cardiol . 1982;  50 1051-1054
  • 109 Cotrufo M, De Luca S L T, Calabro R. Coumarin anticoagulation during pregnancy in patients with mechanical valve prostheses.  Eur J Cardiothorac Surg . 1991;  5 500-505
  • 110 Dashe J S, Ramin K D, Ramin S M. Pregnancy following cardiac transplantation.  Prim Care Update Ob/Gyn . 1998;  5 257-262
  • 111 Scott J R, Wagoner L E, Olsen S L, Taylor D O, Renlund D G. Pregnancy in heart transplant recipients: management and outcome.  Obstet Gynecol . 1993;  82 324-327
  • 112 Kim K M, Sukhani R, Slogoff S, Tomich P G. Central hemodynamic changes associated with pregnancy in a long-term cardiac transplant recipient.  Am J Obstet Gynecol . 1996;  174 1651-1653
    >