Acute myocardial infarction (AMI) in pregnant women is a rare but potentially lethal occurrence that should be carefully managed, especially in consideration of cardiac conditions being a rising cause of maternal deaths. Risk factors for AMI occurrence, in addition to typical cardiac-related risk factors, include medical conditions such as (pre) eclampsia, blood transfusions, thrombophilia and postpartum infections. Being older, multigravida or in the third trimester of pregnancy is also associated with an increased risk. The pathophysiological causes underlying AMI in pregnancy are diverse but generally associated with the coagulative and physiological changes related to the pregnancy. The selection of diagnostic modality and treatment options require careful consideration for pregnancy-related changes as well as risk of harm to the patient and fetus. This paper serves to review available literature regarding an extensive range of management issues that directly impact on maternal and fetal outcomes.
Adult ; Female ; Humans ; Myocardial Infarction ; complications ; physiopathology ; therapy ; Pregnancy ; Pregnancy Complications, Cardiovascular ; physiopathology ; therapy ; Young Adult

BACKGROUNDAs the Shanghai Obstetrical Cardiology Intensive Care Center, our hospital has accumulated a large number of clinical data of pregnant women with heart disease. This paper is a retrospective analysis of 1142 pregnancies in women with heart disease so as to evaluate the maternal and fetal outcomes of these patients.

METHODSA retrospective analysis was carried out for pregnancies in 1142 women with heart disease who delivered in Shanghai Obstetrical Cardiology Intensive Care Center between 1993 and 2007.

RESULTSIn this study, main heart diseases in pregnancy were arrhythmia (n = 359, 31.4%), congenital heart disease (CHD; n = 291, 25.5%), and myocarditis and its sequelae (n = 284, 24.9%); based on the functional classification criteria of New York Heart Association (NYHA), more than half (n = 678, 59.4%) of patients were classified NYHA Class I; pregnant women in NHYA Class I-II (n = 951, 83.3%) commonly had arrhythmia, myocarditis and its sequelae, while those in NHYA Class III-IV (n = 191, 16.7%) mainly had CHD, rheumatic heart disease (RHD), cardiopathy induced by hypertensive disorders complicating pregnancy, and peripartum cardiomyopathy (PPCM). Cardiac failure occurred in 97 (8.5%) patients, and 8 (0.7%) maternal deaths and 12 (1.1%) perinatal deaths were reported in this study. Compared with those in NHYA Class I-II, women in NHYA Class III-IV had a significantly lower gestational age at birth (P < 0.05), lower birth weight (P < 0.01), and higher incidence of preterm delivery, small for gestational age and perinatal death (P < 0.01). The incidence of cardiac failure in pregnant women with cardiopathy induced by hypertensive disorders complicating pregnancy and PPCM was relatively high, with a rate of 80% and 52.2%, respectively. After cardiac operation, 131 (90.3%) women were in classified NHYA Class I-II and 14 (9.7%) in NHYA Class III-IV.

CONCLUSIONSArrhythmia is the type of heart disease that has a highest incidence in patients with heart disease in pregnancy, while main types of heart disease that impair cardiac function are CHD and RHD; cardiac failure is more frequently caused by cardiopathy induced by hypertensive disorders complicating pregnancy and PPCM; impaired cardiac function increases perinatal morbidity; cardiac surgery before pregnancy could improve the cardiac function.

Adolescent ; Adult ; Female ; Heart Diseases ; complications ; physiopathology ; surgery ; Hemodynamics ; Humans ; Pregnancy ; Pregnancy Complications, Cardiovascular ; physiopathology ; surgery ; Pregnancy Outcome ; Retrospective Studies

Aortic dissection accompanying with preeclampsia during pregnancy can be lethal to both the mother and the fetus and carries a high mortality. Of the 2 preeclampsia patients with aortic dissection, one was Type B aortic dissection, occurring in postpartum period. The patient was treated medically and underwent catheter-based stent-graft treatment with fenestration technique. Another patient was Type A acute dissection, occurring in the third trimester. This patient was undiagnosed and both died. Although extremely rare, aortic dissection might be a possibility in preeclampsia pregnant women, the differential diagnosis of chest and/or epigastric pain in preeclampia patient should be thoroughly investigated and treated.
Adult ; Aneurysm, Dissecting ; diagnosis ; etiology ; Female ; Humans ; Pre-Eclampsia ; physiopathology ; Pregnancy ; Pregnancy Complications, Cardiovascular

OBJECTIVETo study the relationship between pregnancy-induced hypertension (PIH) and catecholamine levels.

METHODSCatecholamines levels in maternal and fetal blood were determined in 116 patients with PIH and 40 normal control subjects using high performance liquid chromatography. The normal control subjects and PIH cases were selected from patients at term pregnancy receiving elective cesarean section.

RESULTSPlasma norepinephrine (NE) levels were significantly higher in patients with severe PIH than those in control subjects (P < 0.05). Both patients and control subjects had higher NE levels in the umbilical artery blood than in the umbilical vein blood (P < 0.05). NE levels in the umbilical artery blood were five times higher than those in the maternal blood.

CONCLUSIONThe pathogenesis of PIH may relate to catecholamine concentrations in fetus.

Catecholamines ; blood ; Female ; Fetus ; physiopathology ; Humans ; Hypertension ; blood ; Pregnancy ; Pregnancy Complications, Cardiovascular ; blood

Pregnancy outcomes in patients with congenital heart disease have not been fully assessed in Korea. Forty-nine pregnancies that occurred in 34 women with congenital heart disease who registered at our hospital between September 1995 and April 2006 were reviewed. Spontaneous abortions occurred in two pregnancies at 6+1 and 7 weeks, and another two underwent elective pregnancy termination. One maternal death in puerperium occurred in a woman with Eisenmenger syndrome. Maternal cardiac complications were noted in 18.4%, pulmonary edema in 16.3%, symptomatic arrhythmia in 6.1%, deterioration of New York Heart Association (NYHA) functional class by > or =2 in 2.0%, and cardiac death in 2.0%. Independent predictors of adverse maternal cardiac events were an NYHA functional class of > or =3 (odds ratio [OR], 20.3), right ventricular dilation (OR, 21.2), and pulmonary hypertension (OR, 21.8). Neonatal complications occurred in 22.4% of pregnancies and included preterm delivery (16.3%), small for gestational age (12.2%), and neonatal death (2.0%). Independent predictors of adverse neonatal events were pulmonary hypertension (OR, 6.8) and NYHA functional class > or =3 (OR, 23.0). Pregnancy in women with congenital heart disease was found to be significantly associated with maternal cardiac and neonatal complications. Pre-pregnancy counseling and multidisciplinary care involving cardiologists and obstetricians are recommended for women with congenital heart disease contemplating pregnancy.
Abortion, Spontaneous ; Adult ; Female ; Heart Defects, Congenital/complications/*physiopathology ; Humans ; Korea ; Multivariate Analysis ; Obstetrics/methods ; Odds Ratio ; Pregnancy ; Pregnancy Complications, Cardiovascular/physiopathology ; Pregnancy Outcome

OBJECTIVETo investigate the impact of rheumatic heart disease on pregnancy.

METHODSA retrospective study was conducted in 125 pregnant women with rheumatic heart disease. These cases were divided into operation (group A) and non-operation (group B), and the cardiac function, pregnancy complications, gestational weeks, delivery modes and outcomes of pregnancy were compared.

RESULTSThe cardiac function was significantly improved and pregnancy complications reduced after the cardiac operation with extended gestational weeks, showing significant differences between the two groups (P<0.05). One perinatal fetal death without maternal death occurred in group A, as compared with two maternal and two perinatal deaths in group B. Cesarean section was the primary delivery mode in these cases.

CONCLUSIONSurgical interventions can improve the cardiac function, reduce the pregnancy complications and improve the pregnancy outcomes in pregnant women with rheumatic heart disease. Cesarean section is the primary choice for pregnant women with prosthetic heart valve replacement.

Adult ; Cesarean Section ; Female ; Heart Valve Prosthesis Implantation ; Humans ; Pregnancy ; Pregnancy Complications, Cardiovascular ; physiopathology ; surgery ; Pregnancy Outcome ; Retrospective Studies ; Rheumatic Heart Disease ; physiopathology ; surgery ; Young Adult

INTRODUCTIONAtherosclerotic coronary artery thrombosis is the most common cause of acute myocardial infarction.

CLINICAL PICTUREA 30-year-old lady presented with acute peripartum massive anterior ST segment myocardial infarction and cardiogenic shock. This was due to acute Stanford type A aortic dissection with the intimal flap occluding the left coronary ostium. The initial diagnosis was not apparent. Echocardiography confirmed the diagnosis.

TREATMENT AND OUTCOMEShe underwent emergency surgical repair (Bentall procedure). Pathology confirmed underlying idiopathic cystic medial degeneration.

CONCLUSIONA high index of clinical suspicion is required in acute myocardial infarction presenting without traditional cardiovascular risk factors.

Acute Disease ; Adult ; Aneurysm, Dissecting ; complications ; diagnosis ; surgery ; Aortic Aneurysm ; complications ; diagnosis ; surgery ; Echocardiography ; Electrocardiography ; Female ; Humans ; Myocardial Infarction ; etiology ; physiopathology ; Pregnancy ; Pregnancy Complications, Cardiovascular ; Shock, Cardiogenic ; etiology

OBJECTIVE: It is uncertain whether preeclampsia (PE) is caused by pre-existing factors or by pregnancy itself. We want to answer this important question in public health by conducting a large pre-conception cohort in China. METHODS: A prospective and pre-conception cohort study with a target recruitment of 5000 couples who plan to have a baby within 6 months was performed and their conception, delivery, and postpartum were followed up in Liuyang county, Hunan Province of P. R. China. RESULTS: A total of 1915 young couples have been recruited into this unique pre-conception cohort till now. In general, both systolic blood pressure and diastolic blood pressure decreased in early second trimester from pre-conception level but increased in third trimester and at delivery. CONCLUSION The proposed pre-conception cohort study will have important theoretical and practical implications on the prevention of PE and its associated cardiovascular disease risks.
Adult ; Blood Pressure ; physiology ; China ; Female ; Humans ; Pre-Eclampsia ; etiology ; physiopathology ; prevention & control ; Pregnancy ; Pregnancy Complications, Cardiovascular ; physiopathology ; prevention & control ; Prospective Studies ; Young Adult

OBJECTIVETo investigate the changes in circulating bone marrow stem cells in pregnant rabbits after AMI (AMI) and their relationship with estradiol.

METHODSThree groups of rabbits were used, namely pregnancy and AMI group, AMI group without pregnancy, and sham operation group with pregnancy. The ratio of CD90(+) cells in the peripheral blood was determined with flow cytometry in all the rabbits, and serum estradiol level measured. Four weeks after AMI, hemodynamic measurements were carried out. The morphological changes of the myocardial tissues were examined with ImageJ 1.31.

RESULTS AND CONCLUSIONFour weeks after AMI, the two pregnancy groups showed a higher Left ventricular end systolic pressure(LVESP) and+dp/dtmax, lower left ventricular end-diastolic pressure (LVEDP) and -dp/dtmax and high levels of CD90(+) cells in peripheral blood than AMI group without pregnancy (P<0.01). The ratio of circulating CD90(+) cells increased gradually with gestational age and peaked at the end stage of pregnancy. After delivery the circulating CD90+ cell ratio decreased sharply, showing a significant correlation with serum estradiol level (r=0.725, P<0.01). Four weeks after AMI, the pregnancy group had smaller myocardial infarction (MI) volume than the non-pregnant group (22.17+/-6.34% vs 38.86+/-5.97%, P<0.05). Circulating bone marrow stem cells increased during pregnancy with gestational age and peaked at the end stage of pregnancy. Ten days after delivery, the stem cells resumed basically the normal level. The proportion of circulating bone marrow stem cells was significantly correlated with the level of serum estradiol during pregnancy, and mobilization of the bone marrow stem cells induced by acute ischemic event in pregnant rabbits was advanced. 4 weeks after AMI, the pregnant rabbits showed better heart contraction and diastolic function than the non-pregnant ones.

Animals ; Bone Marrow Cells ; cytology ; Estradiol ; blood ; Female ; Hematopoietic Stem Cells ; cytology ; Myocardial Contraction ; Myocardial Infarction ; blood ; physiopathology ; Pregnancy ; Pregnancy Complications, Cardiovascular ; blood ; Rabbits ; Thy-1 Antigens ; blood ; Time Factors