Download PDF
Kardiologie up2date 2012; 08(04): 309-320
DOI: 10.1055/s-0032-1325950
Herzklappenerkrankungen
© Georg Thieme Verlag KG Stuttgart · New York

Herzklappenerkrankungen und Schwangerschaft

Julie Cleuziou
,
Rüdiger Lange
Further Information

Publication History

Publication Date:
20 December 2012 (online)

Also available at
    Permissions and Reprints All articles of this category

Abstract

Cardiovascular events during pregnancy are mostly due to a congenital heart disease. The number of patients with a congenital heart defect reaching adulthood is increasing steadily and therewith the number of women with a congenital heart defect wishing to conceive. Conditions in which a pregnancy should be avoided are rare and include the Eisenmenger syndrome, a pulmonary hypertension, a cyanosis and an aortic dilatation of > 4 cm in Marfan syndrome. Asymptomatic patients with a valvular heart disease tolerate pregnancy well and do not need special interventions. Patients in a functional NYHA class > III and/or an impaired ventricular function should seek treatment before conception. These patients should be treated in specialized centres offering a multidisciplinary approach to that important matter.

Kernaussagen

  • Aufgrund der steigenden Zahl an Erwachsenen mit angeborenen Herzfehlern wird es in Zukunft mehr Patientinnen mit Herzklappenerkrankungen geben, die Kinder bekommen wollen und eine adäquate Beratung brauchen werden.

  • Die wichtigsten physiologischen Veränderungen während der Schwangerschaft mit Einfluss auf das Herz-Kreislauf-System sind die Steigerung des HZV, die Wasserretention, das erhöhte Thromboserisiko und die Dyspnoe.

  • Es gibt nur wenige Kontraindikationen für eine Schwangerschaft: das Eisenmenger-Syndrom, die pulmonale Hypertonie, eine Zyanose und das Marfan-Syndrom mit erweiterter Aorta ascendens.

  • Symptomatische Herzklappenerkrankungen mit einem NYHA-Status > III sollten vor einer geplanten Schwangerschaft behandelt werden.

  • Biologische Herzklappenprothesen sind die Prothesen der Wahl bei jungen Frauen mit Kinderwunsch, da sie keine Antikoagulation benötigen. Eine Schwangerschaft beeinflusst nicht die Haltbarkeit der Klappenprothese und eine Herzklappen-Reoperation ist in entsprechenden Zentren ohne erhöhtes Risiko durchführbar.

  • Patientinnen mit mechanischen Herzklappenprothesen können bei angepasster Antikoagulanziendosis eine erfolgreiche Schwangerschaft haben. Die sicherste Antikoagulation während der Schwangerschaft ist mit Kumarinderivaten gegeben – bei niedriger Dosis ist die teratogene Wirkung gering.

 

  • Literatur

  • 1 Weiss BM, Hess OM. Pulmonary vascular disease and pregnancy: current controversies, management strategies, and perspectives. Eur Heart J 2000; 21: 104-115
    CrossrefPubMedGoogle Scholar
  • 2 Pötzsch O, Kucera P. Von niedrigen Geburtenzahlen und fehlenden Müttern. Wiesbaden: Statistisches Bundesamt; 2012
    Google Scholar
  • 3 Siu SC, Sermer M, Colman JM et al. Prospective multicenter study of pregnancy outcomes in women with heart disease. Circulation 2001; 104: 515-521
    CrossrefPubMedGoogle Scholar
  • 4 Kaemmerer H, Hess J. Adult patients with congenital heart abnormalities: present and future. Dtsch Med Wochenschr 2005; 130: 97-101
    Article in Thieme ConnectPubMedGoogle Scholar
  • 5 Karamlou T, Diggs BS, McCrindle BW et al. A growing problem: maternal death and peripartum complications are higher in women with grown-up congenital heart disease. Ann Thorac Surg 2011; 92: 2193-2198 ;discussion 2198–2199
    CrossrefPubMedGoogle Scholar
  • 6 Opotowsky AR, Siddiqi OK, D’Souza B et al. Maternal cardiovascular events during childbirth among women with congenital heart disease. Heart 2012; 98: 145-151
    CrossrefPubMedGoogle Scholar
  • 7 Klein HH, Pich S. Cardiovascular changes during pregnancy. Herz 2003; 28: 173-174
    CrossrefPubMedGoogle Scholar
  • 8 Regitz-Zagrosek V, Gohlke-Bärwolf C, Geibel-Zehender A et al. Leitlinien herausgegeben vom Vorstand der Deutschen Gesellschaft für Kardiologie – Herz- und Kreislaufforschung e.V. Herzerkrankungen in der Schwangerschaft. Clin Res Cardiol 2008; 7: 1-36
    PubMedGoogle Scholar
  • 9 Simpson EL, Lawrenson RA, Nightingale AL et al. Venous thromboembolism in pregnancy and the puerperium: incidence and additional risk factors from a London perinatal database. BJOG 2001; 108: 56-60
    PubMedGoogle Scholar
  • 10 Horstkotte D, Faßbender D, Piper C. Congenital heart disease and acquired valvular lesions in pregnancy. Herz 2003; 28: 227-239
    CrossrefPubMedGoogle Scholar
  • 11 Bonow RO, Carabello BA, Chatterjee K et al. ACC/AHA 2006 guidelines for the management of patients with valvular heart disease: a report of the American College of Cardiology/American Heart Association. Task Force on Practice Guidelines (Writing Committee to Revise the 1998 Guidelines for the Management of Patients with Valvular Heart Disease) developed in collaboration with the Society of Cardiovascular Anesthesiologists endorsed by the Society for Cardiovascular Angiography and Interventions and the Society of Thoracic Surgeons. J Am Coll Cardiol 2006; 48: e1-e148
    CrossrefPubMedGoogle Scholar
  • 12 Marcus FI, Ewy GA, O’Rourke RA et al. The effect of pregnancy on the murmurs of mitral and aortic regurgitation. Circulation 1970; 41: 795-805
    CrossrefPubMedGoogle Scholar
  • 13 Avila WS, Rossi EG, Ramires JA et al. Pregnancy in patients with heart disease: experience with 1000 cases. Clin Cardiol 2003; 26: 135-142
    CrossrefPubMedGoogle Scholar
  • 14 Blue GM, Kirk EP, Sholler GF et al. Congenital heart disease: current knowledge about causes and inheritance. Med J Aust 2012; 197: 155-159
    CrossrefPubMedGoogle Scholar
  • 15 van Engelen K, Baars MJH, van Rongen LT et al. Adults with congenital heart disease: Patients’ knowledge and concerns about inheritance. Am J Med Genet Part A 2011; 155: 1661-1667
    CrossrefPubMedGoogle Scholar
  • 16 Silversides CK, Coleman JM, Sermaer M et al. Early and intermediate-term outcomes of pregnancy with congenital aortic stenosis. Am J Cardiol 2003; 91: 1386-1389
    CrossrefPubMedGoogle Scholar
  • 17 Sheikh F, Rangwala S, DeSimone C et al. Management of the parturient with severe aortic incompetence. J Cardiothorac Vasc Anesth 1995; 9: 575-577
    CrossrefPubMedGoogle Scholar
  • 18 Hameed A, Karaalp IS, Tummala PP et al. The effect of valvular heart disease on maternal and fetal outcome of pregnancy. J Am Coll Cardiol 2001; 37: 893-899
    CrossrefPubMedGoogle Scholar
  • 19 Elkayam U, Bitar F. Valvular heart disease and pregnancy, part I: native valves. J Am Coll Cardiol 2005; 46: 223-230
    CrossrefPubMedGoogle Scholar
  • 20 De Souza JAM, Martinez EE, Ambrose JA et al. Percutaneous balloon mitral valvuloplasty in comparison with open mitral valve commissurotomy for mitral stenosis during pregnancy. J Am Coll Cardiol 2001; 37: 900-903
    CrossrefPubMedGoogle Scholar
  • 21 Khairy P, Ouyang DW, Fernandes SM et al. Pregnancy outcomes in women with congenital heart disease. Circulation 2006; 113: 517-524
    CrossrefPubMedGoogle Scholar
  • 22 Oakley C, Child A, Jung B et al. Expert consensus document on management of cardiovascular diseases during pregnancy. Eur Heart J 2003; 24: 761-781
    CrossrefPubMedGoogle Scholar
  • 23 Conolly H, Warnes CA. Ebstein’s Anomaly: Outcome of pregnancy. J Am Coll Cardiol 1994; 23: 1194-1198
    CrossrefPubMedGoogle Scholar
  • 24 Shores J, Berger KR, Murphy EA et al. Progression of aortic dilatation and the benefit of long-term beta-adrenergic blockade in Marfan’s syndrome. N Engl J Med 1994; 330: 1335-1341
    CrossrefPubMedGoogle Scholar
  • 25 Campuzans K, Rogue H, Bolwick A et al. Bacterial endocarditis complicating pregnancy: case report and systematic review of the literature. Arch Gynecol Obstet 2003; 268: 251-255
    CrossrefPubMedGoogle Scholar
  • 26 Naber CK, Bauhofer A, Block M et al. S2-Leitlinie zur Diagnostik und Therapie der infektiösen Endokarditis. Z Kardiol 2004; 93: 1005-1021
    CrossrefPubMedGoogle Scholar
  • 27 Bertsche T, Haas M, Oberwittler H et al. Drugs during pregnancy and breastfeeding: new risk categories – antibiotics as a model. Dtsch Med Wochenschr 2006; 131: 1016-1022
    Article in Thieme ConnectPubMedGoogle Scholar
  • 28 Rossouw GJ, Knott-Craig CJ, Barnard PM et al. Intracardiac operation in seven pregnant women. Ann Thorac Surg 1993; 55: 1172-1174
    CrossrefPubMedGoogle Scholar
  • 29 Hall DR, Olivier J, Rossouw GJ et al. Pregnancy outcome in women with prosthetic heart valves. J Obstet Gynaecol 2001; 21: 149-153
    CrossrefPubMedGoogle Scholar
  • 30 Naber CK, Al-Nawas B, Baumgartner H et al. Prophylaxe der infektiösen Endokarditis. DGK Positionspapier. Kardiologe 2007; 1: 243-250
    CrossrefPubMedGoogle Scholar
  • 31 North RA, Sadler L, Stewart AW et al. Long-term survival and valve-related complications in young women with cardiac valve replacement. Circulation 1999; 99: 2669-2676
    CrossrefPubMedGoogle Scholar
  • 32 Yun Kl, Miller DC, Moore KA et al. Durability of the Hancock MO bioprostheses compared with the standard aortic valve bioprostheses. Ann Thorac Surg 1995; 60: 221-228
    CrossrefPubMedGoogle Scholar
  • 33 Born D, Martinez EE, Almeida PA et al. Pregnancy in patients with prosthetic heart valves: the effect of anticoagulation on mother, fetus and neonatal. Am Heart J 1992; 124: 413-417
    CrossrefPubMedGoogle Scholar
  • 34 Sbarouni E, Oakley CM. Outcome of pregnancy in women with valve prostheses. Br Heart J 1994; 71: 196-201
    CrossrefPubMedGoogle Scholar
  • 35 Cleuziou J, Hörer J, Kaemmerer H et al. Pregnancy does not accelerate biological valve degeneration. Int J Cardiol 2010; 145: 418-421
    CrossrefPubMedGoogle Scholar
  • 36 Avila WS, Rossi FG, Grinberg M et al. Influence of pregnancy after bioprosthetic valve replacement in young women: a prospective five-year study. J Heart Valve Dis 2002; 11: 864-869
    PubMedGoogle Scholar
  • 37 Jamieson WRE, Miller DC, Akims CW et al. Pregnancy and bioprostheses: influence of structural valve deterioration. Ann Thorac Surg 1995; 60: 282-287
    CrossrefPubMedGoogle Scholar
  • 38 Badduke ER, Jamieson WR, Miyagishima RT et al. Pregnancy and childbearing in a population with biologic valvular prostheses. J Thorac CardiovascSurg 1991; 102: 179-186
    PubMedGoogle Scholar
  • 39 Lange R, Bleiziffer S, Mazzitelli D et al. Improvements in transcatheter aortic valve implantation outcomes in lower surgical risk patients: a glimpse into the future. J Am Coll Cardiol 2012; 59: 280-287
    CrossrefPubMedGoogle Scholar
  • 40 Myers ML, Lawrie GM, Crawford ES et al. The St. Jude valve prosthesis: analysis of the clinical results in 815 implants and the need for systemic anticoagulation. J Am Coll Cardiol 1989; 13: 57-62
    CrossrefPubMedGoogle Scholar
  • 41 Elkayam U, Bitar F. Valvular heart disease and pregnancy part II: prosthetic valves. J Am Coll Cardiol 2005; 46: 403-410
    CrossrefPubMedGoogle Scholar
  • 42 Vitale N, De Feo M, De Santo LS et al. Dose-dependent fetal complications of warfarin in pregnant women with mechanical heart valves. J Am Coll Cardiol 1999; 33: 1637-1641
    CrossrefPubMedGoogle Scholar
  • 43 Hanania G. Management of anticoagulants during pregnancy. Heart 2001; 86: 125-126
    CrossrefPubMedGoogle Scholar
  • 44 Oran B, Lee-Parritz A, Ansell J. Low molecular weight heparin for the prophylaxis of thromboembolism in women with prosthetic mechanical heart valves during pregnancy. Thromb Haemost 2004; 92: 747-751
    PubMedGoogle Scholar