Tiantian Sun, Hao Che, Jun Zhang, Yufang Lv, Yaguang Liu, Daqi Liu, Jinjing Wu, Sheng Wang, Liyun Zhao
{"title":"分流相关先天性心脏病相关肺动脉高压孕妇的产妇结局:一项回顾性研究","authors":"Tiantian Sun, Hao Che, Jun Zhang, Yufang Lv, Yaguang Liu, Daqi Liu, Jinjing Wu, Sheng Wang, Liyun Zhao","doi":"10.1186/s12871-025-03082-2","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>Studies on pregnant women with shunt-related congenital heart disease (CHD)-associated pulmonary hypertension (PH) are scarce and limited by small sample sizes. This study aimed to describe the outcomes of pregnant women.</p><p><strong>Methods: </strong>Outcomes of pregnant women with shunt-related CHD-associated PH were retrospectively evaluated from 2010 to 2020. PH was diagnosed based on echocardiography. The incidence of maternal death and postoperative vasoactive drug therapy were compared between women with mild-to-moderate and severe PH. The characteristics and factors influencing postoperative vasoactive drug therapy in women with severe PH were studied. Postoperative vasoactive drug therapy was defined as the use of vasoactive drugs for over 48 h after cesarean section or abortion to maintain circulatory stability.</p><p><strong>Results: </strong>A total of 255 pregnant patients with shunt-related CHD-associated PH were enrolled, including 147 with mild-to-moderate pulmonary artery systolic pressure (PASP) of 30-70 mmHg and 108 with severe PH (PASP > 70 mmHg). Overall, women with mild-to-moderate PH had better maternal outcomes than those with severe PH, including the incidence of maternal mortality (0.68% vs. 11.11%, P < 0.001) and postoperative vasoactive drug therapy (2.74% vs. 50.47%, P < 0.001). Gestational week at delivery (OR 0.9, 95% CI[0.82,0.98], P = 0.016), Eisenmenger syndrome (OR 2.64, 95% [1.08,6.64], P = 0.034), and New York Heart Association (NYHA) functional class III to IV (OR 5.22, 95% [1.90,14.35], P < 0.001) were independently associated with postoperative vasoactive drug therapy in pregnant women with severe PH.</p><p><strong>Conclusions: </strong>Women with shunt-related CHD-associated mild to moderate PH had better outcomes than those with severe PH in terms of the incidence of maternal mortality and postoperative vasoactive drug therapy. Multimodal risk assessment, including PH severity, gestational week, Eisenmenger syndrome, and NYHA functional class, may be useful for risk stratification in pregnant women with shunt-related CHD-associated PH.</p>","PeriodicalId":9190,"journal":{"name":"BMC Anesthesiology","volume":"25 1","pages":"299"},"PeriodicalIF":2.6000,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12210779/pdf/","citationCount":"0","resultStr":"{\"title\":\"Maternal outcomes among pregnant women with shunt-related congenital heart disease-associated pulmonary hypertension: a retrospective study.\",\"authors\":\"Tiantian Sun, Hao Che, Jun Zhang, Yufang Lv, Yaguang Liu, Daqi Liu, Jinjing Wu, Sheng Wang, Liyun Zhao\",\"doi\":\"10.1186/s12871-025-03082-2\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Background: </strong>Studies on pregnant women with shunt-related congenital heart disease (CHD)-associated pulmonary hypertension (PH) are scarce and limited by small sample sizes. This study aimed to describe the outcomes of pregnant women.</p><p><strong>Methods: </strong>Outcomes of pregnant women with shunt-related CHD-associated PH were retrospectively evaluated from 2010 to 2020. PH was diagnosed based on echocardiography. The incidence of maternal death and postoperative vasoactive drug therapy were compared between women with mild-to-moderate and severe PH. The characteristics and factors influencing postoperative vasoactive drug therapy in women with severe PH were studied. Postoperative vasoactive drug therapy was defined as the use of vasoactive drugs for over 48 h after cesarean section or abortion to maintain circulatory stability.</p><p><strong>Results: </strong>A total of 255 pregnant patients with shunt-related CHD-associated PH were enrolled, including 147 with mild-to-moderate pulmonary artery systolic pressure (PASP) of 30-70 mmHg and 108 with severe PH (PASP > 70 mmHg). Overall, women with mild-to-moderate PH had better maternal outcomes than those with severe PH, including the incidence of maternal mortality (0.68% vs. 11.11%, P < 0.001) and postoperative vasoactive drug therapy (2.74% vs. 50.47%, P < 0.001). Gestational week at delivery (OR 0.9, 95% CI[0.82,0.98], P = 0.016), Eisenmenger syndrome (OR 2.64, 95% [1.08,6.64], P = 0.034), and New York Heart Association (NYHA) functional class III to IV (OR 5.22, 95% [1.90,14.35], P < 0.001) were independently associated with postoperative vasoactive drug therapy in pregnant women with severe PH.</p><p><strong>Conclusions: </strong>Women with shunt-related CHD-associated mild to moderate PH had better outcomes than those with severe PH in terms of the incidence of maternal mortality and postoperative vasoactive drug therapy. Multimodal risk assessment, including PH severity, gestational week, Eisenmenger syndrome, and NYHA functional class, may be useful for risk stratification in pregnant women with shunt-related CHD-associated PH.</p>\",\"PeriodicalId\":9190,\"journal\":{\"name\":\"BMC Anesthesiology\",\"volume\":\"25 1\",\"pages\":\"299\"},\"PeriodicalIF\":2.6000,\"publicationDate\":\"2025-07-01\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12210779/pdf/\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"BMC Anesthesiology\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.1186/s12871-025-03082-2\",\"RegionNum\":3,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q2\",\"JCRName\":\"ANESTHESIOLOGY\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"BMC Anesthesiology","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1186/s12871-025-03082-2","RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q2","JCRName":"ANESTHESIOLOGY","Score":null,"Total":0}
引用次数: 0
摘要
背景:对分流相关先天性心脏病(CHD)相关肺动脉高压(PH)孕妇的研究很少,而且样本量小。本研究旨在描述孕妇的结局。方法:回顾性评价2010年至2020年分流相关冠心病相关性PH孕妇的结局。超声心动图诊断PH。比较轻至中度和重度PH产妇的产妇死亡率和术后血管活性药物治疗的发生率,探讨重度PH妇女术后血管活性药物治疗的特点及影响因素。术后血管活性药物治疗定义为剖宫产或流产后48小时以上使用血管活性药物维持循环稳定。结果:共纳入255例分流相关冠心病相关PH孕妇,其中147例为轻中度肺动脉收缩压(PASP) 30-70 mmHg, 108例为重度肺动脉收缩压(PASP bb0 -70 mmHg)。总体而言,轻至中度PH患者的孕产妇结局优于重度PH患者,包括孕产妇死亡率(0.68% vs. 11.11%, P)。结论:分流相关冠心病相关的轻至中度PH患者在孕产妇死亡率和术后血管活性药物治疗方面优于重度PH患者。多模式风险评估,包括PH严重程度、妊娠周、艾森曼格综合征和NYHA功能分级,可能有助于分流相关冠心病相关PH孕妇的风险分层。
Maternal outcomes among pregnant women with shunt-related congenital heart disease-associated pulmonary hypertension: a retrospective study.
Background: Studies on pregnant women with shunt-related congenital heart disease (CHD)-associated pulmonary hypertension (PH) are scarce and limited by small sample sizes. This study aimed to describe the outcomes of pregnant women.
Methods: Outcomes of pregnant women with shunt-related CHD-associated PH were retrospectively evaluated from 2010 to 2020. PH was diagnosed based on echocardiography. The incidence of maternal death and postoperative vasoactive drug therapy were compared between women with mild-to-moderate and severe PH. The characteristics and factors influencing postoperative vasoactive drug therapy in women with severe PH were studied. Postoperative vasoactive drug therapy was defined as the use of vasoactive drugs for over 48 h after cesarean section or abortion to maintain circulatory stability.
Results: A total of 255 pregnant patients with shunt-related CHD-associated PH were enrolled, including 147 with mild-to-moderate pulmonary artery systolic pressure (PASP) of 30-70 mmHg and 108 with severe PH (PASP > 70 mmHg). Overall, women with mild-to-moderate PH had better maternal outcomes than those with severe PH, including the incidence of maternal mortality (0.68% vs. 11.11%, P < 0.001) and postoperative vasoactive drug therapy (2.74% vs. 50.47%, P < 0.001). Gestational week at delivery (OR 0.9, 95% CI[0.82,0.98], P = 0.016), Eisenmenger syndrome (OR 2.64, 95% [1.08,6.64], P = 0.034), and New York Heart Association (NYHA) functional class III to IV (OR 5.22, 95% [1.90,14.35], P < 0.001) were independently associated with postoperative vasoactive drug therapy in pregnant women with severe PH.
Conclusions: Women with shunt-related CHD-associated mild to moderate PH had better outcomes than those with severe PH in terms of the incidence of maternal mortality and postoperative vasoactive drug therapy. Multimodal risk assessment, including PH severity, gestational week, Eisenmenger syndrome, and NYHA functional class, may be useful for risk stratification in pregnant women with shunt-related CHD-associated PH.
期刊介绍:
BMC Anesthesiology is an open access, peer-reviewed journal that considers articles on all aspects of anesthesiology, critical care, perioperative care and pain management, including clinical and experimental research into anesthetic mechanisms, administration and efficacy, technology and monitoring, and associated economic issues.