Clinical Analysis Of Pregnancy By Heart Valve Prosthesis Type

【Background】 In developed countries and our country,pregnancy associated with cardiac disease as one of obstetric risk pregnancy, in non direct obstetric deaths,was in the first place. Progress in the surgical technique, especially the cardio valve replacement(CVR),the artificial heart valve technology,and anticoagulant methods improved heart function and the quality of life,ether congenital heart disease(CHD) or rheumatic heart disease(RHD).Severe valvular heart disease women used one or more artificial valve to adapt to the pregnancy. In recent years clinical diagnosis and treatment were deep improvement, but pregnant women with CVR will bring a lot of problems to the obstetrician, such as pregnant women of childbearing age to consider mechanical valve and bioprosthetic valve selection, the best time to pregnancy for the valve replacement women, anticoagulant therapy in the pregnancy, biological valve degeneration, maternal pregnancy management.But there is no reports for comparing outcomes for pregnancy women with bioprosthetic and mechanical valves.【Objective】 The research referenced to the foreign research results, collected and analyzed the clinical date of the pregnancy after the CVR operation,who were treated in the Beijing An Zhen Hospital affiliated to Capital Medical University from 2004 April to 2014 April and whose delivery gestational age not less than 28 weeks. According to the analysis of the original date,we hope to comparison pregnancy outcomes by heart valve prosthesis type, promote scientific management related maternal and provide reference data for related research in China pregnancy associated with postoperative CVR.【Methods】 1.Data collection Retrospective survey in 2004 April to 2014 April in Beijing An Zhen Hospital affiliated to Capital Medical University from all the hospital diagnosed as pregnancy combined heart valve replacement,whose delivery gestational age not less than 28 weeks.The total were 45 cases,whose average age is 29.63 ± 4.10 years, accounting for the same period in the hospital obstetrics delivery quantity of 0.35%(45/12771). The number of days of hospitalization was 12.33 ± 8.57 days. The time from CVR to gestational age was 6.77 ±6.20 years. There were 37 cases of pregnant women with mechanical prosthetic valve replacement,and they taked warfarin for anticoagulation therapy.And there were 8 cases of biological valve replacement. Among the 8 cases of bioprosthetic valve replacement group as the case group, 37 cases of mechanical valve replacement patients as control group. 2.Diagnostic criteria The diagnosis standards of heart disease and valvular replacement were formulated,according to medical history, physical examination, ultrasound Heartbeat auxiliary examination chart, ECG, 24 hour dynamic electrocardiogram, chest X-ray and other necessary examinations. And the women were diagnosised by the heart specialist.On the basis of USA New York Heart Association(NYHA) 1994 plan, according to the patient’s conscious activity ability,the heart function classification of the patients is divided into four level. The diagnosis standards of premature delivery, postpartum hemorrhage and other related concepts were based on Professor Le Jie editor of the seventh edition of Obstetrics and gynecology. The diagnoses of fetal and neonatal were given by obstetricians and pediatricians. 3.Method Through collected and analyse the cases of pregnancy patients complicated with biological valves or mechanical valve replacement,to compare the difference of valve replacement parts, valve replacement in time, termination of pregnancy and heart function classification, pregnancy situation, anticoagulation after valve replacement complications, mode of delivery, mode of anesthesia, neonatal birth weight, neonatal malformations, fetal growth retardation, premature birth, stillbirth,and neonatal complications.To analyse these dates to discuss the patients’ different maternal and child outcome, who had biological heart valve or mechanical heart valve. 4.Statistical analysis SPSS 18.0 statistical software for statistical analysis was used in this study.The numerical data were expressed as the mean and standard deviation(x ± s).Categorical data description were used by percentage(%). Nonparametric test,and x 2- test for R×C table were applicated for data analysis. P < 0.05 indicated statistical significance.【Result】 1. There are 3 embryopahty with a warfarin dose<5mg daily. 2. The pregnancy women with mechanical valve prosthesesand the bioprostheses has no obvious statistical difference on the cardiac functional grading before delivery( P=0.382), the choice of the delivery mode(P=0.793),the time of delivery(P=0.181)and the anesthesia(P=0.532). 3. The amount of the pregnancy women with mechanical valve prostheses is greater than the bioprostheses on the intrapartum and postpartum hemorrhage in 24 hours.(P=0.000). 4. One pregnancy woman with mechanical valve prostheses had heart failure and postpartum death. 5. All perinatal adverseoutcomessoccurred in the pregnancy women with mechanical valve prostheses. 6. There were four postpartum hemorrhage women by two total hysterectomy(the two women had mechanical valve prostheses). 7. The bioprostheses’ neonatal weight were heavierthan the newborns whose motheres with mechanical valve prostheses(p=0.001). 8. In two postpartum follow-up, the dropout rate was 44.4% and 51.11%, respectively.【Conclusion】 1. Pregnancy in women with mechanical valve prostheses has a high meternal complication rate including valve thrombosis and death. 2. Warfarin carry the risk of embryopathy,whith is probably does-dependent,but this may differ between individuals. 3. The differe anticoagulation regiments are discussed in the review. 4. Bioprostheses maybe have a more favourable pregnancy,but the number is small in the review. 5. The follow-up work to be strengthen because the dropout rate is high. The women with serious heart valve disease undertaking pregnancy will face a high risk,whether she chooses biological or a mechanical valve replacement.Such women before pregnancy should receive prepregnancy counseling detailly by cardiologists and obstetrics doctors with expertise in managing patients with CVR during pregnancy and after delivery, and strictly follow the instruction,on time,to reduce the associated risk as much as possible.