Kardiovaskuläre Erkrankungen in der Schwangerschaft

Maximilian A. Muck; Marcus Fischer; Maura M. Zylla; Christina Alessandra Eichstaedt; Nicola Benjamin; Ekkehard Grünig; Andrea Baessler

doi:10.1055/a-2223-2407

Kardiologie up2date, Table of Contents

Kardiologie up2date 2024; 20(03): 269-289
DOI: 10.1055/a-2223-2407

Spezialthemen

Kardiovaskuläre Erkrankungen in der Schwangerschaft

Maximilian A. Muck

,

Marcus Fischer

,

Maura M. Zylla

,

Christina Alessandra Eichstaedt

,

Nicola Benjamin

,

Ekkehard Grünig

,

Andrea Baessler

Abstract

All articles of this category

Herz-Kreislauf-Erkrankungen sind die Hauptursache für schwangerschaftsbedingte Todesfälle, deren Häufigkeit in den letzten Jahrzehnten zugenommen hat [1]. Die Betreuung von Hochrisikopatientinnen erfordert ein kardiologisch-geburtshilfliches Expertenteam. Die folgende Übersicht adressiert die wichtigsten Aspekte beim Management von Herz-Kreislauf-Erkrankungen in der Schwangerschaft.

Schlüsselwörter

kardiovaskulär - Erkrankungen - Schwangerschaft - angeborenen Herzfehler - Hypertonie - Herzklappe - Insuffizienz - Ischämie - Kardiomyopathie

Full Text

References

Literatur
1 Centers for Disease Control and Prevention (CDC). Pregnancy Mortality Surveillance System. Accessed July 29, 2024 at: https://www.cdc.gov/maternal-mortality/php/pregnancy-mortality-surveillance/index.html
2 Fretts RC, Schmittdiel J, McLean FH. et al. Increased Maternal Age and the Risk of Fetal Death. N Engl J Med 1995; 333: 953-957
3 Cunningham FG, Leveno KJ. Childbearing among Older Women — The Message is Cautiously Optimistic. N Engl J Med 1995; 333: 1002-1004
4 Hayes SN, Kim ESH, Saw J. et al. Spontaneous Coronary Artery Dissection: Current State of the Science: A Scientific Statement From the American Heart Association. Circulation 2018; 137: e523-e557
5 Vaidya VR, Arora S, Patel N. et al. Burden of Arrhythmia in Pregnancy. Circulation 2017; 135: 619-621
6 Child JS, Perloff JK, Koos B. Management of Pregnancy and Contraception in congenital Heart Disease. In: Perloff JK, Child JS, Aboulhosn J. Congenital Heart Disease in Adults. London: Saunders/Elsevier; 2008: 504
7 Roos-Hesselink J, Baris L, Johnson M. et al. Pregnancy outcomes in women with cardiovascular disease: evolving trends over 10 years in the ESC Registry Of Pregnancy And Cardiac disease (ROPAC). Eur Heart J 2019; 40: 3848-3855
8 Regitz-Zagrosek V, Roos-Hesselink JW, Bauersachs J. et al. 2018 ESC Guidelines for the management of cardiovascular diseases during pregnancy. Eur Heart J 2018; 39: 3165-3241
9 Chapman AB, Abraham WT, Zamudio S. et al. Temporal relationships between hormonal and hemodynamic changes in early human pregnancy. Kidney Int 1998; 54: 2056-2063
10 Edouard DA, Pannier BM, London GM. et al. Venous and arterial behavior during normal pregnancy. Am J Physiol 1998; 274: H1605-H1612
11 Drenthen W, Pieper PG, Roos-Hesselink JW. et al. Outcome of pregnancy in women with congenital heart disease: a literature review. J Am Coll Cardiol 2007; 49: 2303-2311
12 Siu SC, Sermer M, Harrison DA. et al. Risk and Predictors for Pregnancy-Related Complications in Women With Heart Disease. Circulation 1997; 96: 2789-2794
13 Presbitero P, Somerville J, Stone S. et al. Pregnancy in cyanotic congenital heart disease. Outcome of mother and fetus. Circulation 1994; 89: 2673-2676
14 Drenthen W, Boersma E, Balci A. et al. Predictors of pregnancy complications in women with congenital heart disease. Eur Heart J 2010; 31: 2124-2132
15 Siu S, Chitayat D, Webb G. Pregnancy in women with congenital heart defects: what are the risks?. Heart 1999; 81: 225-226
16 Grünig E, Benjamin N, Krüger U. et al. General measures and supportive therapy for pulmonary arterial hypertension: Updated recommendations from the Cologne Consensus Conference 2018. Int J Cardiol 2018; 272S: 30-36
17 Benjamin N, Resag C, Weinstock K. et al. Allgemeine Therapie der pulmonalarteriellen Hypertonie nach den neuen Leitlinien. Aktuelle Kardiologie 2023; 12: 45-50
18 Humbert M, Kovacs G, Hoeper MM. et al. 2022 ESC/ERS Guidelines for the diagnosis and treatment of pulmonary hypertension. Eur Heart J 2022; 43: 3618-3731
19 Kiely DG, Condliffe R, Webster V. et al. Improved survival in pregnancy and pulmonary hypertension using a multiprofessional approach. BJOG 2010; 117: 565-574
20 Low T-T, Guron N, Ducas R. et al. Pulmonary arterial hypertension in pregnancy-a systematic review of outcomes in the modern era. Pulm Circ 2021; 11
21 Bostock S, Sheares K, Cannon J. et al. The potential effects of pregnancy in a patient with idiopathic pulmonary arterial hypertension responding to calcium channel blockade. Eur Respir J 2017; 50: 1701141
22 Corbach N, Berlier C, Lichtblau M. et al. Favorable Pregnancy Outcomes in Women With Well-Controlled Pulmonary Arterial Hypertension. Front Med (Lausanne) 2021; 8: 689764
23 Kamp JC, Von Kaisenberg C, Greve S. et al. Pregnancy in pulmonary arterial hypertension: Midterm outcomes of mothers and offspring. J Heart Lung Transplant 2021; 40: 229-233
24 Olsson KM, Kamp JC, Hoeper MM. Pregnancy in PAH: Reality is changing. J Heart Lung Transplant 2021; 40: 395-396
25 Hemnes AR, Kiely DG, Cockrill BA. et al. Statement on pregnancy in pulmonary hypertension from the Pulmonary Vascular Research Institute. Pulm Circ 2015; 5: 435-465
26 Sliwa K, van Hagen IM, Budts W. et al. Pulmonary hypertension and pregnancy outcomes: data from the Registry Of Pregnancy and Cardiac Disease (ROPAC) of the European Society of Cardiology. Eur J Heart Fail 2016; 18: 1119-1128
27 Orwat S, Diller G-P, Van Hagen IM. et al. Risk of Pregnancy in Moderate and Severe Aortic Stenosis. J Am Coll Cardiol 2016; 68: 1727-1737
28 Ducas RA, Javier DA, D’Souza R. et al. Pregnancy outcomes in women with significant valve disease: a systematic review and meta-analysis. Heart 2020; 106: 512-519
29 Silversides CK, Colman JM, Sermer M. et al. Early and intermediate-term outcomes of pregnancy with congenital aortic stenosis. Am J Cardiol 2003; 91: 1386-1389
30 Yap SC, Drenthen W, Pieper PG. et al. Risk of complications during pregnancy in women with congenital aortic stenosis. Int J Cardiol 2008; 126: 240-246
31 Vahanian A, Beyersdorf F, Praz F. et al. 2021 ESC/EACTS Guidelines for the management of valvular heart disease. Eur Heart J 2022; 43: 561-632
32 Van Hagen IM, Roos-Hesselink JW, Ruys TPE. et al. Pregnancy in Women With a Mechanical Heart Valve: Data of the European Society of Cardiology Registry of Pregnancy and Cardiac Disease (ROPAC). Circulation 2015; 132: 132-142
33 Nishimura RA, Otto CM, Bonow RO. et al. 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. Circulation 2014; 129: 2440-2492
34 Pfaller B, Dave Javier A, Grewal J. et al. Risk Associated With Valvular Regurgitation During Pregnancy. J Am Coll Cardiol 2021; 77: 2656-2664
35 Otto CM, Nishimura RA, Bonow RO. et al. 2020 ACC/AHA Guideline for the Management of Patients With Valvular Heart Disease: Executive Summary: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. Circulation 2021; 143: e35-e71
36 De Santo LS, Romano G, Corte AD. et al. Mitral mechanical replacement in young rheumatic women: Analysis of long-term survival, valve-related complications, and pregnancy outcomes over a 3707-patient-year follow-up. J Thorac Cardiovasc Surg 2005; 130: 13-19
37 Lawley CM, Lain SJ, Algert CS. et al. Prosthetic heart valves in pregnancy, outcomes for women and their babies: a systematic review and meta-analysis. BJOG 2015; 122: 1446-1455
38 Minissian MB, Mehta PK, Hayes SN. et al. Ischemic Heart Disease in Young Women. J Am Coll Cardiol 2022; 80: 1014-1022
39 Tweet MS, Lewey J, Smilowitz NR. et al. Pregnancy-Associated Myocardial Infarction: Prevalence, Causes, and Interventional Management. Circ Cardiovasc Interv 2020; 13: e008687
40 Halpern DG, Weinberg CR, Pinnelas R. et al. Use of Medication for Cardiovascular Disease During Pregnancy: JACC State-of-the-Art Review. J Am Coll Cardiol 2019; 73: 457-476
41 Mauricio R, Khera A. Statin Use in Pregnancy: Is It Time For a Paradigm Shift?. Circulation 2022; 145: 496-498
42 James AH, Jamison MG, Biswas MS. et al. Acute myocardial infarction in pregnancy: a United States population-based study. Circulation 2006; 113: 1564-1571
43 Nallamothu BK, Saint M, Saint S. et al. Double Jeopardy. N Engl J Med 2005; 353: 75-80
44 Windram J, Grewal J, Bottega N. et al. Canadian Cardiovascular Society: Clinical Practice Update on Cardiovascular Management of the Pregnant Patient. Can J Cardiol 2021; 37: 1886-1901
45 Ibanez B, James S, Agewall S. et al. 2017 ESC Guidelines for the management of acute myocardial infarction in patients presenting with ST-segment elevation: The Task Force for the management of acute myocardial infarction in patients presenting with ST-segment elevation of the European Society of Cardiology (ESC). Eur Heart J 2018; 39: 119-177
46 Gédéon T, Akl E, D’Souza R. et al. Acute Myocardial Infarction in Pregnancy. Curr Probl Cardiol 2022; 47: 101327
47 Alameh A, Jabri A, Aleyadeh W. et al. Pregnancy-Associated Myocardial Infarction: A Review of Current Practices and Guidelines. Curr Cardiol Rep 2021; 23: 142
48 Sliwa K, Hilfiker-Kleiner D, Petrie MC. et al. Current state of knowledge on aetiology, diagnosis, management, and therapy of peripartum cardiomyopathy: a position statement from the Heart Failure Association of the European Society of Cardiology Working Group on peripartum cardiomyopathy. Eur J Heart Fail 2010; 12: 767-778
49 Bauersachs J, König T, Van Der Meer P. et al. Pathophysiology, diagnosis and management of peripartum cardiomyopathy: a position statement from the Heart Failure Association of the European Society of Cardiology Study Group on peripartum cardiomyopathy. Eur J Heart Fail 2019; 21: 827-843
50 Rakisheva A, Sliwa K, Bauersachs J. et al. Multidisciplinary care of peripartum heart failure: A scientific statement of the Heart Failure Association of the ESC. Eur J Heart Fail 2024; 26: 742-753
51 Jackson AM, Macartney M, Brooksbank K. et al. A 20-year population study of peripartum cardiomyopathy. Eur Heart J 2023; 44: 5128-5141
52 Davis MB, Arany Z, McNamara DM. et al. Peripartum Cardiomyopathy. J Am Coll Cardiol 2020; 75: 207-221
53 Hilfiker-Kleiner D, Haghikia A, Berliner D. et al. Bromocriptine for the treatment of peripartum cardiomyopathy: a multicentre randomized study. Eur Heart J 2017; 38: 2671-2679
54 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 2010; 121: 1465-1473
55 Badianyama M, Das PK, Gaddameedi SR. et al. A Systematic Review of the Utility of Bromocriptine in Acute Peripartum Cardiomyopathy. Cureus 2021; 13: e18248
56 Sliwa K, Fett J, Elkayam U. Peripartum cardiomyopathy. Lancet 2006; 368: 687-693
57 Krul SPJ, Van Der Smagt JJ, Van Den Berg MP. et al. Systematic review of pregnancy in women with inherited cardiomyopathies. Eur J Heart Fail 2011; 13: 584-594
58 Pieper PG, Walker F. Pregnancy in women with hypertrophic cardiomyopathy. Neth Heart J 2013; 21: 14-18
59 Grewal J, Siu SC, Ross HJ. et al. Pregnancy Outcomes in Women With Dilated Cardiomyopathy. J Am Coll Cardiol 2009; 55: 45-52
60 Yokouchi-Konishi T, Kamiya CA, Shionoiri T. et al. Pregnancy outcomes in women with dilated cardiomyopathy: Peripartum cardiovascular events predict post delivery prognosis. J Cardiol 2021; 77: 217-223
61 Peters S, James PA, Fatkin D. et al. Pregnancy Outcomes in Females With Dilated Cardiomyopathy–Associated Rare Genetic Variants. Circ Genom Precis Med 2022; 15: e003540
62 Spracklen TF, Chakafana G, Schwartz PJ. et al. Genetics of Peripartum Cardiomyopathy: Current Knowledge, Future Directions and Clinical Implications. Genes 2021; 12: 103
63 Bollen IAE, Van Deel ED, Kuster DWD. et al. Peripartum cardiomyopathy and dilated cardiomyopathy: different at heart. Front Physiol 2015; 5: 531
64 Tanous D, Siu SC, Mason J. et al. B-Type Natriuretic Peptide in Pregnant Women With Heart Disease. J Am Coll Cardiol 2010; 56: 1247-1253
65 Bauersachs J, Arrigo M, Hilfiker-Kleiner D. et al. Current management of patients with severe acute peripartum cardiomyopathy: practical guidance from the Heart Failure Association of the European Society of Cardiology Study Group on peripartum cardiomyopathy. Eur J Heart Fail 2016; 18: 1096-1105
66 Sliwa K, Van Der Meer P, Petrie MC. et al. Risk stratification and management of women with cardiomyopathy/heart failure planning pregnancy or presenting during/after pregnancy: a position statement from the Heart Failure Association of the European Society of Cardiology Study Group on Peripartum Cardiomyopathy. Eur J Heart Fail 2021; 23: 527-540
67 Eckardt L. [Cardiac arrhythmias in pregnancy : Epidemiology, clinical characteristics, and treatment options]. Herzschrittmacherther Elektrophysiol 2021; 32: 137-144
68 Joglar JA, Kapa S, Saarel EV. et al. 2023 HRS expert consensus statement on the management of arrhythmias during pregnancy. Heart Rhythm 2023; 20: e175-e264
69 Duncker D, Haghikia A, König T. et al. Risk for ventricular fibrillation in peripartum cardiomyopathy with severely reduced left ventricular function—value of the wearable cardioverter/defibrillator. Eur J Heart Fail 2014; 16: 1331-1336
70 Stepan H, Kuse-Föhl S, Klockenbusch W. et al. Diagnosis and Treatment of Hypertensive Pregnancy Disorders. Guideline of DGGG (S1-Level, AWMF-Registernr: 015/018, December 2013). Geburtshilfe Frauenheilkd 2015; 75: 900-914
71 Bujold E, Roberge S, Lacasse Y. et al. Prevention of Preeclampsia and Intrauterine Growth Restriction With Aspirin Started in Early Pregnancy: A Meta-Analysis. Obstet Gynecol 2010; 116: 402-414
72 Seidler AL, Askie L, Ray JG. Optimal aspirin dosing for preeclampsia prevention. Am J Obstet Gynecol 2018; 219: 117-118
73 Tita AT, Szychowski JM, Boggess K. et al. Treatment for Mild Chronic Hypertension during Pregnancy. N Engl J Med 2022; 386: 1781-1792
74 Podymow T, August P. Antihypertensive Drugs in Pregnancy. Semin Nephrol 2011; 31: 70-85
75 Awaludin A, Rahayu C, Daud NAA. et al. Antihypertensive Medications for Severe Hypertension in Pregnancy: A Systematic Review and Meta-Analysis. Healthcare 2022; 10: 325
76 Deutsche Gesellschaft für Gynäkologie und Geburtshilfe e.V. (DGGG). S2k-Leitlinie Hypertensive Erkrankungen in der Schwangerschaft (HES): Diagnostik und Therapie. 2024 Accessed July 29, 2024 at: https://register.awmf.org/de/leitlinien/detail/015-018
77 Wu R, Wang T, Gu R. et al. Hypertensive Disorders of Pregnancy and Risk of Cardiovascular Disease-Related Morbidity and Mortality: A Systematic Review and Meta-Analysis. Cardiology 2020; 145: 633-647