Kernaussagen
Bei Patientinnen mit Herzklappenfehlern ist vor der Schwangerschaft eine klinische
und echokardiografische Untersuchung zu empfehlen, um die LV-Funktion und das Ausmaß
des Herzfehlers zu bestimmen. Das mütterliche Risiko ist in den folgenden Fällen deutlich
erhöht:
-
eingeschränkte LV-Funktion
-
obstruktives Vitium
-
vorangegangene kardiale Dekompensationen
-
thromboembolische Ereignisse
Treffen mehrere dieser Risikofaktoren zu, sollte von einer Schwangerschaft abgeraten
werden. Patientinnen mit Herzfehlern sollten in jedem Trimenon kardiologisch untersucht
werden.
Bei mechanischen Herzklappen sollte zwischen der 6. und 12. Woche sowie nach der 36. Woche
eine Antikoagulation von Phenprocoumon auf unfraktioniertes oder niedermolekulares
Heparin umgestellt werden. Dabei ist die engmaschige Kontrolle und sorgfältige Gerinnungseinstellung
von entscheidender Bedeutung. Die Anwendung von niedermolekularem Heparin zur Antikoagulation
ist umstritten, da niedermolekulares Heparin bei Patienten mit Herzklappenersatz bisher
nicht zugelassen ist und es keine randomisierte Studie gibt, in der geprüft wurde,
ob ein niedermolekulares Heparin für Herzklappenpatienten anzuwenden ist.
Literatur
- 1
Peters R M, Flack J M.
Hypertensive disorders of pregnancy.
J Obstet Gynecol Neonatal Nurs.
2004;
33
209-220
- 2
Stangl V, Schad J, Gossing G et al.
Maternal heart disease and pregnancy outcome: a single-centre experience.
Eur J Heart Fail.
2008;
10
855-860
- 3
Siu S C, Sermer M, Colman J M et al.
Prospective multicenter study of pregnancy outcomes in women with heart disease.
Circulation.
2001;
104
515-521
- 4
Pearson G D, Veille J C, Rahimtoola S et al.
Peripartum cardiomyopathy: National Heart, Lung, and Blood Institute and Office of
Rare Diseases (National Institutes of Health) workshop recommendations and review.
J Am Med Assoc.
2000;
283
1183-1188
- 5
Campos O, Andrade J L, Bocanegra J et al.
Physiologic multivalvular regurgitation during pregnancy: a longitudinal Doppler echocardiographic
study.
Int J Cardiol.
1993;
40
265-272
- 6
Siu S C, Colman J M, Sorensen S et al.
Adverse neonatal and cardiac outcomes are more common in pregnant women with cardiac
disease.
Circulation.
2002;
105
2179-2184
- 7
Drenthen W, Boersma E, Balci A et al.
Predictors of pregnancy complications in women with congenital heart disease.
Eur Heart J.
2010;
31
2124-2132
- 8
Qasqas S A, McPherson C, Frishman W H et al.
Cardiovascular pharmacotherapeutic considerations during pregnancy and lactation.
Cardiol Rev.
2004;
12
201-221
- 9
Zipes D P, Camm A J, Borggrefe M et al.
ACC / AHA / ESC 2006 guidelines for management of patients with ventricular arrhythmias
and the prevention of sudden cardiac death: a report of the American College of Cardiology / American
Heart Association Task Force and the European Society of Cardiology Committee for
Practice Guidelines (writing committee to develop guidelines for management of patients
with ventricular arrhythmias and the prevention of sudden cardiac death): developed
in collaboration with the European Heart Rhythm Association and the Heart Rhythm Society.
Circulation.
2006;
114
e385-e484
- 10
Uebing A, Steer P J, Yentis S M et al.
Pregnancy and congenital heart disease.
Br Med J.
2006;
332
401-406
- 11
Patel J J, Mitha A S, Hassen F et al.
Percutaneous balloon mitral valvotomy in pregnant patients with tight pliable mitral
stenosis.
Am Heart J.
1993;
125
1106-1109
- 12
Silversides C K, Colman J M, Sermer M et al.
Early and intermediate-term outcomes of pregnancy with congenital aortic stenosis.
Am J Cardiol.
2003;
91
1386-1389
- 13
Muscal E, Brey R L.
Neurological manifestations of the antiphospholipid syndrome: risk assessments and
evidence-based medicine.
Int J Clin Pract.
2007;
61
1561-1568
- 14
North R A, Sadler L, Stewart A W et al.
Long-term survival and valve-related complications in young women with cardiac valve
replacements.
Circulation.
1999;
99
2669-2676
- 15
Sadler L, McCowan L, White H et al.
Pregnancy outcomes and cardiac complications in women with mechanical, bioprosthetic
and homograft valves.
Br J Obstet Gynaecol.
2000;
107
245-253
- 16
Gohlke-Barwolf C, Acar J, Oakley C et al.
Guidelines for prevention of thromboembolic events in valvular heart disease. Study
Group of the Working Group on Valvular Heart Disease of the European Society of Cardiology.
Eur Heart J.
1995;
16
1320-1330
- 17
Chan W S, Anand S, Ginsberg J S.
Anticoagulation of pregnant women with mechanical heart valves: a systematic review
of the literature.
Arch Intern Med.
2000;
160
191-196
- 18
Bonow R O, Carabello B A, Kanu C 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.
Circulation.
2006;
114
e84-e231
- 19
Regitz-Zagrosek V, Blomstrom Lundqvist C, Borghi C et al.
ESC Guidelines on the management of cardiovascular diseases during pregnancy: The
Task Force on the Management of Cardiovascular Diseases during Pregnancy of the European
Society of Cardiology (ESC).
Eur Heart J.
2011;
32
3147-3197
Prof. Dr. I. Ott
Deutsches Herzzentrum
Lazarettstr. 36
80636 München
Email: ott@dhm.mhn.de
