Herzklappenerkrankungen und Schwangerschaft

Abstract

Cardiovascular events during pregnancy are mostly due to a congenital heart disease. The number of patients with a congenital heart defect reaching adulthood is increasing steadily and therewith the number of women with a congenital heart defect wishing to conceive. Conditions in which a pregnancy should be avoided are rare and include the Eisenmenger syndrome, a pulmonary hypertension, a cyanosis and an aortic dilatation of > 4 cm in Marfan syndrome. Asymptomatic patients with a valvular heart disease tolerate pregnancy well and do not need special interventions. Patients in a functional NYHA class > III and/or an impaired ventricular function should seek treatment before conception. These patients should be treated in specialized centres offering a multidisciplinary approach to that important matter.

Kernaussagen

• Aufgrund der steigenden Zahl an Erwachsenen mit angeborenen Herzfehlern wird es in Zukunft mehr Patientinnen mit Herzklappenerkrankungen geben, die Kinder bekommen wollen und eine adäquate Beratung brauchen werden.

• Die wichtigsten physiologischen Veränderungen während der Schwangerschaft mit Einfluss auf das Herz-Kreislauf-System sind die Steigerung des HZV, die Wasserretention, das erhöhte Thromboserisiko und die Dyspnoe.

• Es gibt nur wenige Kontraindikationen für eine Schwangerschaft: das Eisenmenger-Syndrom, die pulmonale Hypertonie, eine Zyanose und das Marfan-Syndrom mit erweiterter Aorta ascendens.

• Symptomatische Herzklappenerkrankungen mit einem NYHA-Status > III sollten vor einer geplanten Schwangerschaft behandelt werden.

• Biologische Herzklappenprothesen sind die Prothesen der Wahl bei jungen Frauen mit Kinderwunsch, da sie keine Antikoagulation benötigen. Eine Schwangerschaft beeinflusst nicht die Haltbarkeit der Klappenprothese und eine Herzklappen-Reoperation ist in entsprechenden Zentren ohne erhöhtes Risiko durchführbar.

• Patientinnen mit mechanischen Herzklappenprothesen können bei angepasster Antikoagulanziendosis eine erfolgreiche Schwangerschaft haben. Die sicherste Antikoagulation während der Schwangerschaft ist mit Kumarinderivaten gegeben – bei niedriger Dosis ist die teratogene Wirkung gering.

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