Abstract
With increasing maternal age and the presence of comorbid conditions such as hypertension, cardiovascular assessment and monitoring is the responsibility of all clinicians caring for pregnant patients. Furthermore, there are specific conditions, such as mitral stenosis, peripartum cardiomyopathy, and preeclampsia, that can be associated with heart failure and secondary maternal (and fetal) mortality and morbidity. The important causes of heart failure in pregnancy are discussed.
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Katz R, Karliner JS, Resnik R. Effects of a natural volume overload state (pregnancy) on left ventricular performance in normal human subjects. Circulation. 1978;58:434–41.
Hill JA, Olson EN. Cardiac plasticity. N Engl J Med. 2008;358:1370–80.
Siu SC, Sermer M, Harrison DA, et al. Risk and predictors for pregnancy-related complications in women with heart disease. Circulation. 1997;96:2789–94.
• Siu SC, Sermer M, Colman JM, et al. Prospective multicenter study of pregnancy outcomes in women with heart disease. Circulation. 2001;104:515–21. The investigators prospectively enrolled 562 consecutive pregnant women with heart disease in 13 Canadian cardiac and obstetric teaching hospitals to ascertain maternal cardiac risk in 599 pregnancies not ending in miscarriage.
•• Carapetis JR, McDonald M, Wilson NJ. Acute rheumatic fever. Lancet. 2005;366:155–68. This is a comprehensive review of rheumatic fever worldwide\.
Gorlin R, Gorlin SG. Hydraulic formula for calculation of the area of the stenotic mitral valve, other cardiac valves, and central circulatory shunts. I Am Heart J. 1951;41:1–29.
Kannan M, Vijayanand G. Mitral stenosis and pregnancy: Current concepts in anaesthetic practice. Indian J Anaesth;54:439–44.
Madazli R, Sal V, Cift T, Guralp O, Goymen A. Pregnancy outcomes in women with heart disease. Arch Gynecol Obstet;281:29–34.
Carabello BA. Modern management of mitral stenosis. Circulation. 2005;112:432–7.
• Prendergast BD, Shaw TR, Iung B, Vahanian A, Northridge DB. Contemporary criteria for the selection of patients for percutaneous balloon mitral valvuloplasty. Heart. 2002;87:401–4. This is an important article discussing the importance of commissural calcification as a predictor of outcome and complications following percutaneous balloon mitral valvuloplasty.
Sutaria N, Northridge DB, Shaw TR. Significance of commissural calcification on outcome of mitral balloon valvotomy. Heart. 2000;84:398–402.
• Bhatla N, Lal S, Behera G, et al. Cardiac disease in pregnancy. Int J Gynaecol Obstet. 2003;82:153–9. Retrospective analysis of 207 pregnancies in women in whom isolated mitral stenosis was the predominant problem emphasizing the importance of NYHA Cardiac class as a determinant of maternal and fetal outcomes.
• Fawzy ME, Kinsara AJ, Stefadouros M, et al. Long-Term outcome of mitral balloon valvotomy in pregnant women. J Heart Valve Dis. 2001;10:153–7. A discussion of the 5-year outcome of 23 patients with severe, symptomatic mitral stenosis having mitral balloon valvuloplasty in the 2nd trimester of pregnancy.
Routray SN, Mishra TK, Swain S, Patnaik UK, Behera M. Balloon mitral valvuloplasty during pregnancy. Int J Gynaecol Obstet. 2004;85:18–23.
Ventura SJ, Peters KD, Martin JA, Maurer JD. Births and deaths: United States, 1996. Mon Vital Stat Rep. 1997;46:1–40.
Brar SS, Khan SS, Sandhu GK, et al. Incidence, mortality, and racial differences in peripartum cardiomyopathy. Am J Cardiol. 2007;100:302–4.
• Sliwa K, Fett J, Elkayam U. Peripartum cardiomyopathy. Lancet. 2006;368:687–93. A contemporary review of the subject by two experts in the field.
Pearson GD, Veille JC, 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. JAMA. 2000;283:1183–8.
Elkayam U, Akhter MW, Singh H, et al. Pregnancy-associated cardiomyopathy: clinical characteristics and a comparison between early and late presentation. Circulation. 2005;111:2050–5.
Hibbard JU, Lindheimer M, Lang RM. A modified definition for peripartum cardiomyopathy and prognosis based on echocardiography. Obstet Gynecol. 1999;94:311–6.
Sliwa K, Forster O, Libhaber E, et al. Peripartum cardiomyopathy: inflammatory markers as predictors of outcome in 100 prospectively studied patients. Eur Heart J. 2006;27:441–6.
• Sliwa K, Skudicky D, Candy G, Bergemann A, Hopley M, Sareli P. The addition of pentoxifylline to conventional therapy improves outcome in patients with peripartum cardiomyopathy. Eur J Heart Fail. 2002;4:305–9. An important clinical proof of concept trial in the treatment of peripartum cardiomyopathy.
•• Hilfiker-Kleiner D, Kaminski K, Podewski E, et al. A cathepsin D-cleaved 16 kDa form of prolactin mediates postpartum cardiomyopathy. Cell. 2007;128:589–600. An extremely important study showing that a biologically active derivative of prolactin mediates peripartum cardiomyopathy.
•• Sliwa K, Blauwet L, Tibazarwa K, et al. Evaluation of bromocriptine in the treatment of acute severe peripartum cardiomyopathy: a proof-of-concept pilot study. Circulation;121:1465–73. Important Clinical Study showing that when Bromocryptine was added to standard therapy in patients with peripartum cardiomyopathy there appeared to be improved cardiac function and clinical outcomes.
Yamac H, Bultmann I, Sliwa K, Hilfiker-Kleiner D. Prolactin: a new therapeutic target in peripartum cardiomyopathy. Heart;96:1352–7.
Felker GM, Thompson RE, Hare JM, et al. Underlying causes and long-term survival in patients with initially unexplained cardiomyopathy. N Engl J Med. 2000;342:1077–84.
•• Elkayam U, Tummala PP, Rao K, et al. Maternal and fetal outcomes of subsequent pregnancies in women with peripartum cardiomyopathy. N Engl J Med. 2001;344:1567–71. Important study addressing outcomes of subsequent pregnancies in patients with peripartum cardiomyopathy.
• Lampert MB, Weinert L, Hibbard J, Korcarz C, Lindheimer M, Lang RM. Contractile reserve in patients with peripartum cardiomyopathy and recovered left ventricular function. Am J Obstet Gynecol. 1997;176:189–95. A clinical study highlighting the concept of assessing contractile reserve in patients with peripartum cardiomyopathy.
Cunningham FG, Pritchard JA, Hankins GD, Anderson PL, Lucas MJ, Armstrong KF. Peripartum heart failure: idiopathic cardiomyopathy or compounding cardiovascular events? Obstet Gynecol. 1986;67:157–68.
Zinaman M, Rubin J, Lindheimer MD. Serial plasma oncotic pressure levels and echoencephalography during and after delivery in severe pre-eclampsia. Lancet. 1985;1:1245–7.
Fillmore SJ, Parry EH. The evolution of peripartal heart failure in Zaria, Nigeria. Some etiologic factors. Circulation. 1977;56:1058–61.
Ford L, Abdullahi A, Anjorin FI, et al. The outcome of peripartum cardiac failure in Zaria, Nigeria. QJM. 1998;91:93–103.
Davidson NM, Parry EH. Peri-partum cardiac failure. Q J Med. 1978;47:431–61.
Cenac A, Djibo A. Postpartum cardiac failure in Sudanese-Sahelian Africa: clinical prevalence in western Niger. Am J Trop Med Hyg. 1998;58:319–23.
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Rutherford, J.D. Heart Failure in Pregnancy. Curr Heart Fail Rep 9, 277–281 (2012). https://doi.org/10.1007/s11897-012-0105-9
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DOI: https://doi.org/10.1007/s11897-012-0105-9