Pregnancy Outcomes in Women With Rheumatic Mitral Valve Disease: Results From the Registry of Pregnancy and Cardiac Disease.

Détails

ID Serval
serval:BIB_B7BD5E5011A4
Type
Article: article d'un périodique ou d'un magazine.
Collection
Publications
Institution
Titre
Pregnancy Outcomes in Women With Rheumatic Mitral Valve Disease: Results From the Registry of Pregnancy and Cardiac Disease.
Périodique
Circulation
Auteur⸱e⸱s
van Hagen I.M., Thorne S.A., Taha N., Youssef G., Elnagar A., Gabriel H., ElRakshy Y., Iung B., Johnson M.R., Hall R., Roos-Hesselink J.W., Bouchardy Judith, Rutz Tobias
Collaborateur⸱rice⸱s
ROPAC Investigators and EORP Team
ISSN
1524-4539 (Electronic)
ISSN-L
0009-7322
Statut éditorial
Publié
Date de publication
20/02/2018
Peer-reviewed
Oui
Volume
137
Numéro
8
Pages
806-816
Langue
anglais
Notes
Publication types: Clinical Trial ; Journal Article ; Multicenter Study ; Research Support, Non-U.S. Gov't
Publication Status: ppublish
Résumé
Cardiac disease is 1 of the major causes of maternal mortality. We studied pregnancy outcomes in women with rheumatic mitral valve disease.
The Registry of Pregnancy and Cardiac Disease is an international prospective registry, and consecutive pregnant women with cardiac disease were included. Pregnancy outcomes in all women with rheumatic mitral valve disease and no prepregnancy valve replacement is described in the present study (n=390). A maternal cardiac event was defined as cardiac death, arrhythmia requiring treatment, heart failure, thromboembolic event, aortic dissection, endocarditis, acute coronary syndrome, and hospitalization for other cardiac reasons or cardiac intervention. Associations between patient characteristics and cardiac outcomes were checked in a 3-level model (patient-center-country).
Most patients came from emerging countries (75%). Mitral stenosis (MS) with or without mitral regurgitation (MR) was present in 273 women, isolated MR in 117. The degree of MS was mild in 20.9%, moderate in 39.2%, severe in 19.8%, and severity not classified in the remainder. Maternal death during pregnancy occurred in 1 patient with severe MS. Hospital admission occurred in 23.1% of the women with MS, and the main reason was heart failure (mild MS 15.8%, moderate 23.4%, severe 48.1%; P<0.001). Heart failure occurred in 23.1% of patients with moderate or severe MR. An intervention during pregnancy was performed in 16 patients, 14 had percutaneous balloon mitral commissurotomy, and 2 had surgical valve replacement (1 for MS, 1 for MR). In multivariable modeling, prepregnancy New York Heart Association class >1 was an independent predictor of maternal cardiac events. Follow-up at 6 months postpartum was available for 53%, and 3 more patients died (1 with severe MS, 1 with moderate MS, 1 with moderate to severe MR).
Although mortality was only 1.9% during pregnancy, ≈50% of the patients with severe rheumatic MS and 23% of those with significant MR developed heart failure during pregnancy. Prepregnancy counseling and considering mitral valve interventions in selected patients are important to prevent these complications.
Mots-clé
Adult, Female, Humans, Mitral Valve Insufficiency/mortality, Mitral Valve Insufficiency/therapy, Models, Cardiovascular, Pregnancy, Pregnancy Complications, Cardiovascular/mortality, Pregnancy Complications, Cardiovascular/therapy, Pregnancy Outcome, Prospective Studies, Registries, Rheumatic Heart Disease/mortality, Rheumatic Heart Disease/therapy, pregnancy, rheumatic heart disease, valvular heart disease, women, women and minorities
Pubmed
Web of science
Open Access
Oui
Création de la notice
20/09/2019 15:12
Dernière modification de la notice
04/09/2021 6:35
Données d'usage