medigraphic.com
ISSN 1561-3011 (Electronic)

2022, Number 1

<< Back Next >>

Rev Cubana Invest Bioméd 2022; 41 (1)

Management of mitral stenosis during pregnancy

Vasallo PR, Román RPA, Vázquez HG, Gil JY, Meluzá MM, Gallinat MY

Language: Spanish
References: 16
Page: 1-10
PDF size: 278.26 Kb.


ABSTRACT

Heart disease complicates about 4% of pregnancies; and represent the leading non-obstetric cause of maternal death. Valvular lesions have a high prevalence, being mitral stenosis the one with the worst prognosis during pregnancy. This article aims to present the recommendations of the National Heart Disease and Pregnancy Service for the management of mitral stenosis during pregnancy. Evaluation of valve anatomy and disease severity is crucial. Moderate to severe injuries should be treated with cardioselective beta-blockers and elective percutaneous commissurotomy, if the anatomy is favorable. If there is volume retention, diuretics are indicated. Among the drugs for obstetric use, prostaglandins, nifedipine and fenoterol are contraindicated. The time of termination of pregnancy depends on the gestational age and the appearance of signs of maternal or fetal decompensation, in which case they have an indication for cesarean section.


REFERENCES

  1. Samuel Avila W, Giunco Alexandre R, de Castro M, et al. Posicionamento da SociedadeBrasileira de Cardiologia para Gravidez e Planejamento Familiar na Mulher Portadora deCardiopatia – 2020. Arq.Bras. Cardiol.2020[acceso 15/08/2021]; 114(5): 849-942.Disponible en: https://doi.org/10.36660/abc.20200406

  2. ACOG practice bulletin No. 212: pregnancy and heart disease. Obstet Gynecol 2019[acceso 15/08/2021];133:e320–56. Disponible en:https://pubmed.ncbi.nlm.nih.gov/310222123

  3. Lewey J, Andrade L, Levine L. Valvular Heart Disease in Pregnancy. Cardiol Clin 39(2021) 151–161. Disponible en: https://doi.org/10.1016/j.ccl.2020.09.010

  4. Muryán S, Malvino E. Cuidados intensivos cardiológicos en pacientes obstétricas.Argentina. 2aed.; 2020 [acceso 15/08/2021]. Disponible en: www.obstetriciacritica.com

  5. Archivos del Servicio Nacional de Cardiopatía y Embarazo (SNCE). 2000-2021.Hospital Ramón González Coro. [acceso 15/08/2021]. Disponible en:https://instituciones.sld.cu/hospgramonglezcoro/

  6. Ki Park, MD, Bairey C, Bello N, Davis M, et al. Management ofWomen WithAcquiredCardiovascular Disease From Pre-Conception Through Pregnancy andPostpartum. JACC. 2021; 77(14). Disponible en: https://doi.org/10.1016/j.jacc.2021.01.057

  7. Regitz V, Roos J, Bauersachs J. Guía ESC 2018 sobre el tratamiento de las enfermedadescardiovasculares durante el embarazo. Rev Esp Cardiol. 2019;72(2):161.e1-e65. Disponibleen: http://doi.org/10.1016/j.recesp.2018.12.004

  8. Guimarães T, Magalhães A, Veiga A, et al. Cardiopatia e gravidez, o estado da arte. RevPort Cardiol. 2019;38(5):373---383. Disponible en:https://doi.org/10.1016/j.repc.2018.05.013

  9. Sharma G, Ying W, Silversides C. The Importance of Cardiovascular Risk Assessmentand Pregnancy Heart Team in the Management of Cardiovascular Disease in PregnancyCardiol Clin 39 (2021) 7–19. Disponible en: https://doi.org/10.1016/j.ccl.2020.09.002

  10. U.S. Department of Health and Human Services, Food and Drug Administration, Centerfor Drug Evaluation and Research, Center for Biologics Evaluation and Research.Reviewer guidance: evaluating the risks of drug exposure inhuman pregnancies. 2005. [acceso 15/08/2021]. Disponible en:https://www.fda.gov/regulatory-information/search-fda-guidance-documents/evaluatingrisks-drug-exposure-human-pregnancies

  11. Ersboll AS, Hedegaard M, Sondergaard L, Ersboll M, Johansen M. Treatment with oralbetablockers during pregnancy complicated by maternal heart disease increases the risk offetal growth restriction. BJOG. 2014; 121(5):618-26.

  12. Bianchi A, Blasina F, Castillo E, et al. Glucocorticoides prenatales. Documentouruguayo de consenso. Archi Pediatr Urug 2018; 83(3):179-186. Disponible en:https://dx.doi.org/10.31134/AP.89.3.5

  13. 2020 ACC/AHA Guideline for the Management of Patients With Valvular HeartDisease. Circulation. 2021;143:e00–e00. Disponible en:https://doi.org/10.1161/CIR.0000000000000923

  14. Surabhi N, Catherine N, Mackillop L. Cardiac disease in pregnancy. Clinical Medicine2012; 12(6): 553–560. Disponible en: https://dx.doi.org/ 10.7861/clinimedicine.12-6-553.

  15. Del Pilar Alvares M, Diaz Carrillo MA. Insuficiencia cardiaca aguda secundaria aestenosis mitral reumática durante el puerperio. Med Crit 2018[acceso15/08/2021];32(3):160-163. Disponible en:http://www.scielo.org.mx/scielo.php?script=sci_arttext&pid=S2448-89092018000300160&lng=es

  16. Laxmi S, Mehta M, Chair C, Warner M. Cardiovascular Considerations in Caring forPregnant Patients A Scientific Statement From the American Heart Association.Circulation. 2020;141:e884–e903. Disponible en:https://doi.org/10.1161/CIR.0000000000000772




2020     |     www.medigraphic.com