妊娠期先天性心脏病妇女导航:管理策略和未来方向。

IF 1.9 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS
Bibhuti B Das, Varun Aggarwal, Shriprasad R Deshpande
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引用次数: 0

摘要

患有成人先天性心脏病(CHD)的女性在怀孕期间面临着独特的挑战,因为妊娠期心血管(CV)和血流动力学的变化会加剧潜在的心脏疾病。虽然这些适应性在心脏结构和功能正常的女性中具有良好的耐受性,但对于成年CHD (ACHD)患者,无论是修复,缓解还是残留缺陷,它们都具有显著的风险。孕妇冠心病与不良心血管事件的风险增加有关,包括中风、心力衰竭、心律失常和妊娠期和围产期血栓栓塞并发症。有效的管理需要一个多学科的团队,包括心脏病专家、围产期医生、麻醉师和其他熟练的护理提供者。风险分层工具,如改进的世界卫生组织分类、CARPREG II和ZAHARA评分,对于预测孕产妇和胎儿结局和指导临床决策是有用的。孕前咨询在评估个体风险、优化心功能和教育患者潜在并发症方面起着关键作用。未来的研究应优先考虑创新疗法,包括靶向药物和微创干预,以及改进筛查方法,在症状性疾病出现之前识别高风险患者。本文综述了目前关于处理妊娠期ACHD的文献,强调了临床实践中的差距,并探讨了未来加强护理的方向。解决这些挑战对于改善孕产妇和胎儿结局以及确保在整个生殖过程中全面、以患者为中心的护理至关重要。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Navigating women with congenital heart disease during pregnancy: Management strategies and future directions.

Women with adult congenital heart disease (CHD) face unique challenges during pregnancy, as gestational cardiovascular (CV) and hemodynamic changes can exacerbate underlying cardiac conditions. While these adaptations are well tolerated in women with structurally and functionally normal hearts, they pose significant risks for those with adult CHD (ACHD), whether repaired, palliated, or with residual defects. Maternal CHD is associated with an increased risk of adverse CV events, including stroke, heart failure, arrhythmias, and thromboembolic complications during pregnancy and the peripartum period. Effective management requires a multidisciplinary team, including cardiologists, perinatologists, anesthesiologists, and other skilled care providers. Risk stratification tools such as the modified World Health Organization classification, CARPREG II, and ZAHARA scores are useful for predicting maternal and fetal outcomes and guiding clinical decision-making. Preconception counseling plays a critical role in assessing individual risks, optimizing cardiac function, and educating patients about potential complications. Future research should prioritize innovative therapies, including targeted pharmacological agents and minimally invasive interventions, alongside improved screening methods to identify high-risk patients before symptomatic disease manifests. This review synthesizes current literature on managing pregnant women with ACHD, highlights gaps in clinical practice, and explores future directions to enhance care. Addressing these challenges is essential to improving maternal and fetal outcomes and ensuring comprehensive, patient-centered care throughout the reproductive journey.

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来源期刊
World Journal of Cardiology
World Journal of Cardiology CARDIAC & CARDIOVASCULAR SYSTEMS-
CiteScore
3.30
自引率
5.30%
发文量
54
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