Download Dr. Tavoosi pregnancy_0

Anahita Tavoosi, MD
Assistant Professor
of Cardiology
Pulmonary arterial
hypertension
Severe systemic
ventricular
dysfunction (LVEF
<30%, NYHA III–IV
Pregnancy is
contraindicated!
Severe mitral
stenosis, severe
symptomatic
aortic stenosis
-Marfan syndrome
with aorta dilated >45
mm
-Aortic dilatation >50
mm in aortic disease
associated with
bicuspid aortic valve
Previous
peripartum
cardiomyopathy
with any residual
impairment of left
ventricular function
Native severe
Coarctation
‫‬‫‬‫‬‫‬‫‬‫‬‫‬‫‬‫‪-‬‬
‫هر بیماری دریچه ای که به نارسایی منجربه‬
‫‪ 4‬و ‪ Function Class 3‬رسیده باشد و غیر قابل برگشت به ‪ 2‬باشد‬
‫هر نوع مسایل حاد قلبی غیرازكرونركه به‪ 4‬و‪ Function Class 3‬رسیده باشد؛از‬
‫قبیلمیوكاردیك و پریكاردیك ‪.‬‬
‫سابقه بیماری كاردیومایو پاتی دیالته در حاملگی های قبلی‬
‫سندرم مارفان در صورتی كه قطر آئورت صعودی بیش از ‪ 5‬سانتی متر باشد‬
‫سندرم ایزن منگر‬
‫فشارخون غیرقابل كنترل با داروهای مجاز در دوران حاملگی‬
‫هر بیماری ریوی به شرط ایجاد افزایش فشارخون ریوی حتی از نوع خفیف‬
‫تواناییانعقادی افزون یافتهكهتجویز هپارین منجربه تشدید بیماری دیگری شود كه‬
‫جان مادر را تهدید نماید‬
A 31 year old woman
Attended the Imam Hospital cardiology clinic at 8
weeks gestation
Was referred due to a heart murmur
After doing echocardiography she was found to have a
BAV
Moderate Aortic Regurgitation
AA was dilated(5.1cm)
Cyanotic heart disease
(unrepaired)
Mechanical valve
Other complex
congenital heart
disease
Pregnancy is not
Recommended!
Fontan circulation
• Aortic dilatation
40–45 mm in Marfan
syndrome
• Aortic dilatation
45–50 mm in aortic
disease bicuspid
aortic valve
Systemic right
ventricle
A 23 year old woman
Attended the Imam Hospital cardiology clinic at 11
weeks gestation
Was referred due to a heart murmur
After doing echocardiography she was found to
have a severe mitral stenosis
Mean gradient of
9 mmHg
MVA:1.2cm2
Good left
ventricular and RV
function
Mild to moderate
aortic
regurgitation
PAP was 45mmHg
Heart failure :
Occurs frequently in (area <1.5 cm2) in the
second and third trimesters
The rates of prematurity are 20% to 30%,
Fetal growth restriction 5% to 20%
Stillbirth (1% to 3%)
The patient was monthly visited by cardiologist
Beta-blocker and diuretic was prescribed for her
She was okay till 28th weeks when her FC
deteriorated to II-III
The echocardiography showed
MeanPG:14mmHG, and PAP:55mmHg
Although the medical therapy was initiated in CCU
the patients FC became worst
PTMC
Surgery
Pregnancy Termination
PTMC was not successful
Surgery associates with 20-30% fetal loss
A 41 year old woman
Attended the Imam Hospital cardiology clinic at 32
weeks gestation
Referred due to a dyspnea FC II-III
After doing echocardiography she was found to have
Severe Mitral Regurgitation
Moderate MS(Mean PG:8mmHg,MVA:1.8cm2 and
mean gradient of 8 mmHg)
Mild to moderate TR, TRG:47mmHg, PAP:52mmHg
Mild aortic regurgitation
Good left ventricular function
Induced labor
Spontaneous
onset of labor
Gravida’s cardiac status
Bishop score
A score based upon the station of the presenting
part and four characteristics of the cervix:
dilatation, effacement, consistency, and position
Fetal well-being
Lung maturity