Pregnancy management and spontaneous labor in heart diseases: present-day solution to the dilemma
- 作者: Mravyan S.R.1, Petrukhin V.A.1, Zarudskiy A.A.1, Pronina V.P.1, Mravyan SR1, Petrukhin VA1, Zaprudsky AA1, Pronina VP1
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- 期: 卷 81, 编号 10 (2009)
- 页面: 9-15
- 栏目: Editorial
- ##submission.dateSubmitted##: 09.04.2020
- ##submission.datePublished##: 15.10.2009
- URL: https://ter-arkhiv.ru/0040-3660/article/view/30518
- ID: 30518
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Subjects and methods. Ninety-six 19-to-37 year-old (mean age 28.3±9.4 years) women at 35-39 weeks gestational age were examined. All the women were diagnosed as having congenital or acquired (rheumatic) heart disease. Their hemodynamics and CRV were analyzed according to the type of hemodynamic overload, for which purpose three patient groups were formed: 1) volume overload; 2) pressure overload; and 3) combined overload. A control group comprised 40 healthy pregnant women. Before and 2-3 days after delivery, all the women underwent 24-hour Holter cardiac rhythm monitoring with the estimation of the temporary and spectral parameters of CRV.
Results. In antepartum heart diseases accompanied by volume overload, there was a tendency for total CRV (SDNN 95.4 ± 15.8 msec versus 125.5 ± 17.8 msec in the controls) to decrease and for sympathetic activity to significantly increase (SDANN 65.7 ± 13.7 and 109.9 ± 14.7 msec, respectively; p < 0.05). When pressure overload (a moderate gradient) developed, the temporary parameters of total CRV, sympathetic and parasympathetic activities did not differ from those in the control group. Heart diseases attended by pressure overload and a high gradient were characterized by a significant reduction in total CRV (100.5 ± 24.6 msec; p < 0.05) as compared with those in patients having a moderate pressure gradient, with a declining trend for total spectrum power, Group 3 patients showed a reduction in all the indices reflecting the temporary and spectral characteristics, suggesting a considerable rise in sympathetic activity and a decrease in total autonomic spectrum power.
Conclusion. Based on SRV studies, indications for prolonged pregnancy and spontaneous or, in some cases, surgical delivery can be assessed in pregnant women with heart diseases.
作者简介
Sergey Mravyan
Email: lakmoniiag@mail.ru
Vasiliy Petrukhin
Email: lakmoniiag@mail.ru
Aleksandr Zarudskiy
Email: okb@bel.ru
Viktoriya Pronina
Email: moniki@mоnikiweb.ru
S Mravyan
V Petrukhin
A Zaprudsky
V Pronina
参考
- Основные показатели деятельности акушерско-гинекологической службы Российской Федерации в разрезе федеральных округов (стат. материалы). М.; 2007.
- Reimold S. C., Rutherford J. D. Valvular heart disease in pregnancy. N. Engl. J. Med. 2003; 349: 52-59.
- ACC/AHA 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 (Committee on Management of Patients with Valvular Heart Disease). J. Am. Coll. Cardiol. 1998; 32: 1486-1588.
- Maqueda I. G., Romero E. A., Recasens J. D. Guias de practica clinica de la Sociedad Espanola de Cardiologia en la gestante con cardiopatia. Rev. Esp. Cardiol. 2000; 53: 1474-1495.
- Кулешова А. Г. Исходы беременности при различных гемодинамических группах врожденных пороков сердца. Патол. кровообращ. и кардиохир. 2001; 2: 12-18.
- Приказ Минздравсоцразвития № 736 от 05.12.07 "Перечень медицинских" показаний к прерыванию беременности". М.; 2007.
- Макацария А. Д., Беленков Ю. Н., Вейман А. П. (ред.). Беременность и врожденные пороки сердца. М.: Руссо; 2001.
- Abdel-Hady E. S., El-Shamy M., El-Rifai A. A. Maternal and perinatal outcome of pregnancies complicated by cardiac disease. Int. J. Gynaecol. Obstetr. 2005; 90: 21-25.
- Khairy P., Ouyang D. W., Fernandes S. M. et al. Pregnancy outcomes in women with congenital heart disease. Circulation. 2006; 113: 517-524.
- Breuer H. W. Auscultation of the heart in pregnancy Münch. Med. Wschr. 1981; 123: 1705-1707.
- Арболишвили Г. Н., Мареев В. И., Орлова Л. А., Беленков И. Н. Вариабельность сердечного ритма при хронической сердечной недостаточности и ее роль в прогнозе заболевания. Кардиология 2006; 46 (12): 4-11.
- Глотова О. В. Оптимизация акушерской тактики у больных с митральным пороком сердца: Автореф. дис.... канд. мед. наук. 2005.
- Frankenstein L., Nelles M., Slavutsky M. et al. Beta-blockers influence the short-term and long-term prognostic information of natriuretic peptides and catecholamines in chronic heart failure independent from specific agents. J. Heart Lung Transplant. 2007; 26: 1033-1039.
- Kimura K., Ieda M., Kanazawa H. et al. Cardiac sympathetic rejuvenation: a link between nerve function and cardiac hypertrophy. Circ. Res. 2007; 100: 1755-1764.
- Kiriazis H., Du X. J., Feng X. et al. Preserved left ventricular structure and function in mice with cardiac sympathetic hyperinnervation. Am. J. Physiol. 2005; 289: H1359-H1365.
- Freed L. A., Stein K. M., Borer J. S. et al. Relation of ultra-low frequency heart rate variability to the clinical course of chronic aortic regurgitation. Am. J. Cardiol. 1997; 79: 1482-1487.
- Blase A., Carabello B. The relationship of left ventricular geometry and hypertrophy to left ventricular function in valvular heart disease, J. Heart Valv. Dis., 1995; 4 (suppl. II): 132-139.
- Yamada Y., Okumura K., Hashimoto H. et al. Altered myocardial acetylcholine and norepinephrine concentrations in right ventricular hypertrophy and failure. Heart Vessels, 1991; 6: 150-157.
- Lindpaintner K., Lund D. D., Schmid P. O. Effects of chronic progressive myocardial hypertrophy on indexes of cardiac autonomic innervation. Circ. Res. 1987; 61: 55-62.
- Mandawat M. K., Wallbridge D. R., Pringle S. D. et al. Heart rate variability in left ventricular hypertrophy. Br Heart J. 1995; 73: 139-144.
- Alter P., Grimm W., Vollrath A. et al. Heart rate variability in patients with cardiac hypertrophy-relation to left ventricular mass and etiology. Am. Heart J. 2006; 151: 829-836.
- Arora R., Krummerman A., Vijayaraman P. Heart rate variability and diastolic heart failure. Pacing Clin. Electrophysiol. 2004; 27: 299-303.
- Modesti P. A., Vanni S., Bertolozzi I. et al. Different growth factor activation in the right and left ventricles in experimental volume overload. Hypertension 2004; 43: 101-108.
- Gatzoulis M. A., Balaji S., Webber S. A. et al. Risk factors for arrhythmia and sudden cardiac death late after repair of tetralogy of Fallot: a multicentre study. Lancet 2000; 356: 975-981.
- Khairy P., Landzberg M. J., Gatzoulis M. A. et al. Value of programmed ventricular stimulation after tetralogy of Fallot repair: a multicenter study. Circulation, 2004; 109: 1994-2000.
- Niwa K., Tateno S., Akagi T. et al. Arrhythmia and reduced heart rate variability during pregnancy in women with congenital heart disease and previous reparative surgery. Int. J. Cardiol. 2007; 122: 143-148.
- Murphy J. G., Gersh B. J., Mair D. D. et al. Long-term outcome in patients undergoing surgical repair of tetralogy of Fallot. N. Engl. J. Med. 1993; 329: 593-599.
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