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Care During Pregnancy

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Pregnancy and Congenital Heart Disease

Part of the book series: Congenital Heart Disease in Adolescents and Adults ((CHDAA))

Abstract

Pregnancy in women with cardiovascular disease should be guided by a multidisciplinary team of cardiologists, obstetricians and anesthesiologists with expertise in this field. Follow-up of women includes a regular echocardiographic assessment, depending on the underlying cardiac disease. Other diagnostic modalities are generally preserved for patients with potential deterioration of their cardiac function, or should be postponed until after delivery. Medication during pregnancy should carefully be considered for their potential fetotoxicity. Anticoagulation strategies in particular should be thoroughly discussed with the patient, preferably before pregnancy, and require close follow-up during pregnancy. A management and delivery plan for every pregnant woman with cardiac disease may be based on the WHO classification, and individualised based on clinical parameters.

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Abbreviations

DIC:

Disseminated intravascular coagulation

FDA:

Food and Drug Administration

LMWH:

Low-molecular-weight heparin

WHO:

World Health Organization

References

  1. Task Force on the Management of Cardiovascular Diseases During Pregnancy of the European Society of C (2003) Expert consensus document on management of cardiovascular diseases during pregnancy. Eur Heart J 24(8):761–781

    Article  Google Scholar 

  2. Vahanian A, Alfieri O, Andreotti F, Antunes MJ, Baron-Esquivias G, Baumgartner H, Borger MA, Carrel TP, De Bonis M, Evangelista A, Falk V, Lung B, Lancellotti P, Pierard L, Price S, Schafers HJ, Schuler G, Stepinska J, Swedberg K, Takkenberg J, Von Oppell UO, Windecker S, Zamorano JL, Zembala M, Guidelines ESCCfP, Joint Task Force on the Management of Valvular Heart Disease of the European Society of C, European Association for Cardio-Thoracic S (2012) Guidelines on the management of valvular heart disease (version 2012): the Joint Task Force on the Management of Valvular Heart Disease of the European Society of Cardiology (ESC) and the European Association for Cardio-Thoracic Surgery (EACTS). Eur J Cardiothorac Surg 42(4):S1–S44

    Article  PubMed  Google Scholar 

  3. Regitz-Zagrosek V, Lundqvist CB, Borghi C, Cifkova R, Ferreira R, Foidart JM, Gibbs JSR, Gohlke-Baerwolf C, Gorenek B, Iung B, Kirby M, Maas AHEM, Morais J, Nihoyannopoulos P, Pieper PG, Presbitero P, Roos-Hesselink JW, Schaufelberger M, Seeland U, Torracca L, Bax J, Auricchio A, Baumgartner H, Ceconi C, Dean V, Deaton C, Fagard R, Funck-Brentano C, Hasdai D, Hoes A, Knuuti J, Kolh P, McDonagh T, Moulin C, Poldermans D, Popescu BA, Reiner Z, Sechtem U, Sirnes PA, Torbicki A, Vahanian A, Windecker S, Baumgartner H, Deaton C, Aguiar C, Al-Attar N, Garcia AA, Antoniou A, Coman I, Elkayam U, Gomez-Sanchez MA, Gotcheva N, Hilfiker-Kleiner D, Kiss RG, Kitsiou A, Konings KTS, Lip GYH, Manolis A, Mebaaza A, Mintale I, Morice MC, Mulder BJ, Pasquet A, Price S, Priori SG, Salvador MJ, Shotan A, Silversides CK, Skouby SO, Stein JI, Tornos P, Vejlstrup N, Walker F, Warnes C, Force T, CPG ECPG (2011) 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 32(24):3147–3197

    Article  PubMed  Google Scholar 

  4. Balci A, Sollie-Szarynska KM, van der Bijl AG, Ruys TP, Mulder BJ, Roos-Hesselink JW, van Dijk AP, Wajon EM, Vliegen HW, Drenthen W, Hillege HL, Aarnoudse JG, van Veldhuisen DJ, Pieper PG, investigators Z-I (2014) Prospective validation and assessment of cardiovascular and offspring risk models for pregnant women with congenital heart disease. Heart 100(17):1373–1381

    Article  PubMed  Google Scholar 

  5. Lu CW, Shih JC, Chen SY, Chiu HH, Wang JK, Chen CA, Chiu SN, Lin MT, Lee CN, Wu MH (2015) Comparison of 3 risk estimation methods for predicting cardiac outcomes in pregnant women with congenital heart disease. Circ J 79(7):1609–1617

    Article  PubMed  Google Scholar 

  6. van Hagen IM, Boersma E, Johnson MR, Thorne SA, Parsonage WA, Escribano Subías P, Leśniak-Sobelga A, Irtyuga O, Sorour KA, Taha N, Maggioni AP, Hall R, Roos-Hesselink JW, on behalf of the ROPAC investigators and EORP team (2016) Global cardiac risk assessment in the Registry of Pregnancy and Cardiac disease: results of a registry from the European Society of Cardiology. Eur J Heart Fail 18:523–533

    Article  PubMed  Google Scholar 

  7. Robson SC, Hunter S, Boys RJ, Dunlop W (1989) Serial study of factors influencing changes in cardiac output during human pregnancy. Am J Physiol 256(4 Pt 2):H1060–H1065

    CAS  PubMed  Google Scholar 

  8. Sunitha M, Chandrasekharappa S, Brid SV (2014) Electrocardiographic Qrs axis, Q wave and T-wave changes in 2nd and 3rd trimester of normal pregnancy. J Clin Diagn Res 8(9):BC17–BC21

    Google Scholar 

  9. Melchiorre K, Sharma R, Thilaganathan B (2012) Cardiac structure and function in normal pregnancy. Curr Opin Obstet Gynecol 24(6):413–421

    Article  PubMed  Google Scholar 

  10. Dogan V, Basaran O, Altun I, Biteker M (2014) Transesophageal echocardiography guidance is essential in the management of prosthetic valve thrombosis. Int J Cardiol 177(3):1103–1104

    Article  PubMed  Google Scholar 

  11. Szymanski LM, Satin AJ (2012) Strenuous exercise during pregnancy: is there a limit? Am J Obstet Gynecol 207(3):179, e171–176

    Article  PubMed  PubMed Central  Google Scholar 

  12. Expert Panel on MRS, Kanal E, Barkovich AJ, Bell C, Borgstede JP, Bradley WG Jr, Froelich JW, Gimbel JR, Gosbee JW, Kuhni-Kaminski E, Larson PA, Lester JW Jr, Nyenhuis J, Schaefer DJ, Sebek EA, Weinreb J, Wilkoff BL, Woods TO, Lucey L, Hernandez D (2013) ACR guidance document on MR safe practices: 2013. J Magn Reson Imaging 37(3):501–530

    Article  Google Scholar 

  13. Higuchi H, Takagi S, Zhang K, Furui I, Ozaki M (2015) Effect of lateral tilt angle on the volume of the abdominal aorta and inferior vena cava in pregnant and nonpregnant women determined by magnetic resonance imaging. Anesthesiology 122(2):286–293

    Article  PubMed  Google Scholar 

  14. Rossi A, Cornette J, Johnson MR, Karamermer Y, Springeling T, Opic P, Moelker A, Krestin GP, Steegers E, Roos-Hesselink J, van Geuns RJ (2011) Quantitative cardiovascular magnetic resonance in pregnant women: cross-sectional analysis of physiological parameters throughout pregnancy and the impact of the supine position. J Cardiovasc Magn Reson 13:31

    Article  PubMed  PubMed Central  Google Scholar 

  15. Beausejour Ladouceur V, Lawler PR, Gurvitz M, Pilote L, Eisenberg MJ, Ionescu-Ittu R, Guo L, Marelli AJ (2016) Exposure to low-dose ionizing radiation from cardiac procedures in patients with congenital heart disease: 15-year data from a population-based longitudinal cohort. Circulation 133(1):12–20

    Article  PubMed  Google Scholar 

  16. Lazarus E, Debenedectis C, North D, Spencer PK, Mayo-Smith WW (2009) Utilization of imaging in pregnant patients: 10-year review of 5270 examinations in 3285 patients – 1997–2006. Radiology 251(2):517–524

    Article  PubMed  Google Scholar 

  17. Colletti PM, Lee KH, Elkayam U (2013) Cardiovascular imaging of the pregnant patient. AJR Am J Roentgenol 200(3):515–521

    Article  PubMed  Google Scholar 

  18. Damilakis J, Theocharopoulos N, Perisinakis K, Manios E, Dimitriou P, Vardas P, Gourtsoyiannis N (2001) Conceptus radiation dose and risk from cardiac catheter ablation procedures. Circulation 104(8):893–897

    Article  CAS  PubMed  Google Scholar 

  19. Chatterson LC, Leswick DA, Fladeland DA, Hunt MM, Webster S, Lim H (2014) Fetal shielding combined with state of the art CT dose reduction strategies during maternal chest CT. Eur J Radiol 83(7):1199–1204

    Article  PubMed  Google Scholar 

  20. Musallam A, Volis I, Dadaev S, Abergel E, Soni A, Yalonetsky S, Kerner A, Roguin A (2015) A randomized study comparing the use of a pelvic lead shield during trans-radial interventions: threefold decrease in radiation to the operator but double exposure to the patient. Catheter Cardiovasc Interv 85(7):1164–1170

    Article  PubMed  Google Scholar 

  21. Tuzcu V, Gul EE, Erdem A, Kamali H, Saritas T, Karadeniz C, Akdeniz C (2015) Cardiac interventions in pregnant patients without fluoroscopy. Pediatr Cardiol 36(6):1304–1307

    Article  PubMed  Google Scholar 

  22. Drenthen W, Pieper PG, Roos-Hesselink JW, van Lottum WA, Voors AA, Mulder BJ, van Dijk AP, Vliegen HW, Yap SC, Moons P, Ebels T, van Veldhuisen DJ, Investigators Z. (2007) Outcome of pregnancy in women with congenital heart disease: a literature review. J Am Coll Cardiol 49(24):2303–2311

    Article  PubMed  Google Scholar 

  23. Ruys TP, Roos-Hesselink JW, Hall R, Subirana-Domenech MT, Grando-Ting J, Estensen M, Crepaz R, Fesslova V, Gurvitz M, De Backer J, Johnson MR, Pieper PG (2014) Heart failure in pregnant women with cardiac disease: data from the ROPAC. Heart 100(3):231–238

    Article  PubMed  Google Scholar 

  24. Shotan A, Ostrzega E, Mehra A, Johnson JV, Elkayam U (1997) Incidence of arrhythmias in normal pregnancy and relation to palpitations, dizziness, and syncope. Am J Cardiol 79(8):1061–1064

    Article  CAS  PubMed  Google Scholar 

  25. Whittemore R, Hobbins JC, Engle MA (1982) Pregnancy and its outcome in women with and without surgical treatment of congenital heart disease. Am J Cardiol 50(3):641–651

    Article  CAS  PubMed  Google Scholar 

  26. Salam AM, Ertekin E, van Hagen IM, Al Suwaidi J, Ruys TPE, Johnson MR, Gumbiene L, Frogoudaki AA, Sorour KA, Iserin L, Ladouceur M, van Oppen ACC, Hall R, Roos-Hesselink JW (2015) Atrial fibrillation or flutter during pregnancy in patients with structural heart disease data from the ROPAC (Registry on Pregnancy and Cardiac Disease). JACC Clin Electrophysiol 1(4):284–292

    Article  Google Scholar 

  27. Siu SC, Sermer M, Colman JM, Alvarez AN, Mercier LA, Morton BC, Kells CM, Bergin ML, Kiess MC, Marcotte F, Taylor DA, Gordon EP, Spears JC, Tam JW, Amankwah KS, Smallhorn JF, Farine D, Sorensen S, Cardiac Disease in Pregnancy I (2001) Prospective multicenter study of pregnancy outcomes in women with heart disease. Circulation 104(5):515–521

    Article  CAS  PubMed  Google Scholar 

  28. Tateno S, Niwa K, Nakazawa M, Akagi T, Shinohara T, Yasuda T, Study Group for Arrhythmia Late after Surgery for Congenital Heart D (2003) Arrhythmia and conduction disturbances in patients with congenital heart disease during pregnancy: multicenter study. Circ J 67(12):992–997

    Article  PubMed  Google Scholar 

  29. Hodes AR, Tichnell C, Te Riele AS, Murray B, Groeneweg JA, Sawant AC, Russell SD, van Spaendonck-Zwarts KY, van den Berg MP, Wilde AA, Tandri H, Judge DP, Hauer RN, Calkins H, van Tintelen JP, James CA (2015) Pregnancy course and outcomes in women with arrhythmogenic right ventricular cardiomyopathy. Heart [Epub ahead of print]

    Google Scholar 

  30. van Hagen IM, Roos-Hesselink JW, Ruys TP, Merz WM, Goland S, Gabriel H, Lelonek M, Trojnarska O, Al Mahmeed WA, Balint HO, Ashour Z, Baumgartner H, Boersma E, Johnson MR, Hall R, Investigators R, the ERPT (2015) Pregnancy in women with a mechanical heart valve: data of the European Society of Cardiology Registry of Pregnancy and Cardiac Disease (ROPAC). Circulation 132(2):132–142

    Article  PubMed  Google Scholar 

  31. Rossiter JP, Repke JT, Morales AJ, Murphy EA, Pyeritz RE (1995) A prospective longitudinal evaluation of pregnancy in the Marfan syndrome. Am J Obstet Gynecol 173(5):1599–1606

    Article  CAS  PubMed  Google Scholar 

  32. Meijboom LJ, Vos FE, Timmermans J, Boers GH, Zwinderman AH, Mulder BJ (2005) Pregnancy and aortic root growth in the Marfan syndrome: a prospective study. Eur Heart J 26(9):914–920

    Article  PubMed  Google Scholar 

  33. Loeys BL, Schwarze U, Holm T, Callewaert BL, Thomas GH, Pannu H, De Backer JF, Oswald GL, Symoens S, Manouvrier S, Roberts AE, Faravelli F, Greco MA, Pyeritz RE, Milewicz DM, Coucke PJ, Cameron DE, Braverman AC, Byers PH, De Paepe AM, Dietz HC (2006) Aneurysm syndromes caused by mutations in the TGF-beta receptor. N Engl J Med 355(8):788–798

    Article  CAS  PubMed  Google Scholar 

  34. Pepin M, Schwarze U, Superti-Furga A, Byers PH (2000) Clinical and genetic features of Ehlers-Danlos syndrome type IV, the vascular type. N Engl J Med 342(10):673–680

    Article  CAS  PubMed  Google Scholar 

  35. Dawes M, Chowienczyk PJ (2001) Drugs in pregnancy. Pharmacokinetics in pregnancy. Best Pract Res Clin Obstet Gynaecol 15(6):819–826

    Article  CAS  PubMed  Google Scholar 

  36. Nishimura RA, Otto CM, Bonow RO, Carabello BA, Erwin JP 3rd, Guyton RA, O’Gara PT, Ruiz CE, Skubas NJ, Sorajja P, Sundt TM 3rd, Thomas JD, American College of Cardiology/American Heart Association Task Force on Practice G (2014) 2014 AHA/ACC guideline for the management of patients with valvular heart disease: executive summary: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. J Am Coll Cardiol 63(22):2438–2488

    Article  PubMed  Google Scholar 

  37. Goland S, Schwartzenberg S, Fan J, Kozak N, Khatri N, Elkayam U (2014) Monitoring of anti-xa in pregnant patients with mechanical prosthetic valves receiving low-molecular-weight heparin: peak or trough levels? J Cardiovasc Pharmacol Ther 19(5):451–456

    Article  CAS  PubMed  Google Scholar 

  38. Abildgaard U, Sandset PM, Hammerstrom J, Gjestvang FT, Tveit A (2009) Management of pregnant women with mechanical heart valve prosthesis: thromboprophylaxis with low molecular weight heparin. Thromb Res 124(3):262–267

    Article  CAS  PubMed  Google Scholar 

  39. Quinn J, Von Klemperer K, Brooks R, Peebles D, Walker F, Cohen H (2009) Use of high intensity adjusted dose low molecular weight heparin in women with mechanical heart valves during pregnancy: a single-center experience. Haematologica 94(11):1608–1612

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  40. James AH, Brancazio LR, Gehrig TR, Wang A, Ortel TL (2006) Low-molecular-weight heparin for thromboprophylaxis in pregnant women with mechanical heart valves. J Matern Fetal Neonatal Med 19(9):543–549

    Article  CAS  PubMed  Google Scholar 

  41. McLintock C, McCowan LM, North RA (2009) Maternal complications and pregnancy outcome in women with mechanical prosthetic heart valves treated with enoxaparin. BJOG 116(12):1585–1592

    Article  CAS  PubMed  Google Scholar 

  42. Tromp CH, Nanne AC, Pernet PJ, Tukkie R, Bolte AC (2011) Electrical cardioversion during pregnancy: safe or not? Neth Heart J 19(3):134–136

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  43. Barnes EJ, Eben F, Patterson D (2002) Direct current cardioversion during pregnancy should be performed with facilities available for fetal monitoring and emergency caesarean section. BJOG 109(12):1406–1407

    Article  PubMed  Google Scholar 

  44. Brown O (2003) Direct current cardioversion during pregnancy. BJOG 110(7):713–714

    Article  PubMed  Google Scholar 

  45. Szumowski L, Szufladowicz E, Orczykowski M, Bodalski R, Derejko P, Przybylski A, Urbanek P, Kusmierczyk M, Kozluk E, Sacher F, Sanders P, Dangel J, Haissaguerre M, Walczak F (2010) Ablation of severe drug-resistant tachyarrhythmia during pregnancy. J Cardiovasc Electrophysiol 21(8):877–882

    PubMed  Google Scholar 

  46. Authors/Task Force M, Priori SG, Blomstrom-Lundqvist C, Mazzanti A, Blom N, Borggrefe M, Camm J, Elliott PM, Fitzsimons D, Hatala R, Hindricks G, Kirchhof P, Kjeldsen K, Kuck KH, Hernandez-Madrid A, Nikolaou N, Norekval TM, Spaulding C, Van Veldhuisen DJ (2015) 2015 ESC guidelines for the management of patients with ventricular arrhythmias and the prevention of sudden cardiac death: the Task Force for the Management of Patients with Ventricular Arrhythmias and the Prevention of Sudden Cardiac Death of the European Society of Cardiology (ESC) Endorsed by: Association for European Paediatric and Congenital Cardiology (AEPC). Eur Heart J 36(41):2793–2867

    Google Scholar 

  47. Abello M, Peinado R, Merino JL, Gnoatto M, Mateos M, Silvestre J, Dominguez JL (2003) Cardioverter defibrillator implantation in a pregnant woman guided with transesophageal echocardiography. Pacing Clin Electrophysiol 26(9):1913–1914

    Article  PubMed  Google Scholar 

  48. Tuzcu V, Kilinc OU (2012) Implantable cardioverter defibrillator implantation without using fluoroscopy in a pregnant patient. Pacing Clin Electrophysiol 35(9):e265–e266

    Article  PubMed  Google Scholar 

  49. Kuhne M, Schaer B, Reichlin T, Sticherling C, Osswald S (2015) X-ray-free implantation of a permanent pacemaker during pregnancy using a 3D electro-anatomic mapping system. Eur Heart J 36(41):2790

    Article  PubMed  Google Scholar 

  50. Jeejeebhoy FM, Zelop CM, Lipman S, Carvalho B, Joglar J, Mhyre JM, Katz VL, Lapinsky SE, Einav S, Warnes CA, Page RL, Griffin RE, Jain A, Dainty KN, Arafeh J, Windrim R, Koren G, Callaway CW, American Heart Association Emergency Cardiovascular Care Committee CoCCCP, Resuscitation CoCDitY, Council on Clinical C (2015) Cardiac arrest in pregnancy: a scientific statement from the American Heart Association. Circulation 132(18):1747–1773

    Article  PubMed  Google Scholar 

  51. Lipman S, Cohen S, Einav S, Jeejeebhoy F, Mhyre JM, Morrison LJ, Katz V, Tsen LC, Daniels K, Halamek LP, Suresh MS, Arafeh J, Gauthier D, Carvalho JC, Druzin M, Carvalho B, Society for Obstetric A, Perinatology (2014) The Society for Obstetric Anesthesia and Perinatology consensus statement on the management of cardiac arrest in pregnancy. Anesth Analg 118(5):1003–1016

    Article  PubMed  Google Scholar 

  52. Elassy SM, Elmidany AA, Elbawab HY (2014) Urgent cardiac surgery during pregnancy: a continuous challenge. Ann Thorac Surg 97(5):1624–1629

    Article  PubMed  Google Scholar 

  53. John AS, Gurley F, Schaff HV, Warnes CA, Phillips SD, Arendt KW, Abel MD, Rose CH, Connolly HM (2011) Cardiopulmonary bypass during pregnancy. Ann Thorac Surg 91(4):1191–1196

    Article  PubMed  Google Scholar 

  54. Patel A, Asopa S, Tang AT, Ohri SK (2008) Cardiac surgery during pregnancy. Tex Heart Inst J 35(3):307–312

    PubMed  PubMed Central  Google Scholar 

  55. Hosseini S, Kashfi F, Samiei N, Khamoushi A, Ghavidel AA, Yazdanian F, Mirmesdagh Y, Mestres CA (2015) Feto-maternal outcomes of urgent open-heart surgery during pregnancy. J Heart Valve Dis 24(2):253–259

    PubMed  Google Scholar 

  56. Pomini F, Mercogliano D, Cavalletti C, Caruso A, Pomini P (1996) Cardiopulmonary bypass in pregnancy. Ann Thorac Surg 61(1):259–268

    Article  CAS  PubMed  Google Scholar 

  57. Willcox TW, Stone P, Milsom FP, Connell H (2005) Cardiopulmonary bypass in pregnancy: possible new role for the intra-aortic balloon pump. J Extra Corp Technol 37(2):189–191

    Google Scholar 

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Authors and Affiliations

  1. Department of Cardiology, Division of Adult Congenital Heart Disease, Erasmus MC, University Medical Center, 2040, Rotterdam, The Netherlands

    Iris M. van Hagen MD & Jolien W. Roos-Hesselink MD, PhD

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  1. Iris M. van Hagen MD
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  2. Jolien W. Roos-Hesselink MD, PhD
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Correspondence to Iris M. van Hagen MD .

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Editors and Affiliations

  1. Erasmus MC University Medical Center, Rotterdam, Gelderland, The Netherlands

    Jolien W. Roos-Hesselink

  2. Chelsea and Westminster Hospital, London, United Kingdom

    Mark R. Johnson

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van Hagen, I.M., Roos-Hesselink, J.W. (2017). Care During Pregnancy. In: Roos-Hesselink, J., Johnson, M. (eds) Pregnancy and Congenital Heart Disease. Congenital Heart Disease in Adolescents and Adults. Springer, Cham. https://doi.org/10.1007/978-3-319-38913-4_5

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