妊娠合并肺动脉高压诊治进展

doi:10.3969/j.issn.1006-5725.2023.22.010

Abstract

Abstract:

Pulmonary arterial hypertension is a progressive cardiovascular disease caused by multiple factors， with poor prognosis. Pregnancy with pulmonary arterial hypertension is more prone to serious complications such as right heart failure， pulmonary arterial hypertension crisis， malignant arrhythmia， and cardiogenic shock， with a high mortality rate. There is currently no standardized diagnosis and treatment guideline for pregnancy complicated with pulmonary arterial hypertension. In recent years， the diagnosis， treatment， and management of pregnancy complicated with pulmonary arterial hypertension have received attention. This article provides an important explanation of the diagnosis and treatment of pregnancy complicated with pulmonary arterial hypertension， in order to provide reference for clinical practice.

Key words: pulmonary arterial hypertension, pregnancy, risk factors

CLC Number:

R543.2

Yunyan XU,Can ZHANG,Kaili CHANG,Wei LIU,Qian ZHUO,Shengling LI,Zuyi HE,Hailong. DAI. Progress in diagnosis and treatment of pregnancy complicated with pulmonary arterial hypertension[J]. The Journal of Practical Medicine, 2023, 39(22): 2914-2920.

References 57

1	GALIÈ N， MCLAUGHLIN V V， RUBIN L J， et al. An overview of the 6th World Symposium on Pulmonary Hypertension［J］. Eur Respir J， 2019， 53（1）： 1802148.
2	翟振国，王辰.中国肺动脉高压诊断与治疗指南（2021年版）［J］. 中华医学杂志，2021，101（1）：11-51.
3	WEISS B M， ZEMP L， SEIFERT B， et al. Outcome of pulmonary vascular disease in pregnancy： a systematic overview from 1978 through 1996［J］. J Am Coll Cardiol， 1998， 31（7）： 1650-1657.
4	HUMBERT M， KOVACS G， HOEPER M M， et al. 2022 ESC/ERS Guidelines for the diagnosis and treatment of pulmonary hypertension［J］. Eur Respir J， 2023， 61（1）： 2200879.
5	中华医学会妇产科学分会产科学组. 妊娠合并心脏病的诊治专家共识（2016）［J］. 中华妇产科杂志，2016，51（6）：401-409.
6	LIU Y， LI H， LI Y， et al. Outcomes of pregnancy in women with different types of pulmonary hypertension［J］. BMC Cardiovasc Disord， 2023， 23（1）： 391.
7	NAGAYA N， NISHIKIMI T， UEMATSU M， et al. Plasma brain natriuretic peptide as a prognostic indicator in patients with primary pulmonary hypertension［J］. Circulation， 2000， 102（8）： 865-870.
8	WARWICK G， THOMAS P S， YATES D H. Biomarkers in pulmonary hypertension［J］. Eur Respir J， 2008， 32（2）： 503-512.
9	PRASAD C S， KUMAR S， SUMATHY S， et al. Pregnancy and pulmonary arterial hypertension-improving surveillance and outcomes with multidisciplinary care and Nterminal pro-brain natriuretic peptide trends［J］. J Matern Fetal Neonatal Med， 2022， 35（18）：3533-3539.
10	SAVARESE G， PAOLILLO S， COSTANZO P， et al. Do changes of 6-minute walk distance predict clinical events in patients with pulmonary arterial hypertension？ A meta-analysis of 22 randomized trials［J］. J Am Coll Cardiol， 2012， 60（13）： 1192-1201.
11	GABLER N B， FRENCH B， STROM B L， et al. Validation of 6-minute walk distance as a surrogate end point in pulmonary arterial hypertension trials［J］. Circulation， 2012， 126（3）： 349-356.
12	FRITZ J S， BLAIR C， OUDIZ R J， et al. Baseline and follow-up 6-min walk distance and brain natriuretic peptide predict 2-year mortality in pulmonary arterial hypertension［J］. Chest， 2013， 143（2）： 315-323.
13	代爽，冯艳红. 全自动三维超声右心室定量软件评价系统性红斑狼疮患者右心室收缩功能［J］. 实用医学杂志，2023，39（5）：636-641.
14	HAECK M L A， VLIEGEN H W. Diagnosis and treatment of pulmonary hypertension［J］. Heart， 2015， 101（4）： 311-319.
15	MARSHALL W H， GEE S， LIM W， et al. Correlation of echocardiographic probability of pulmonary hypertension with maternal outcomes in pregnant womenwith elevated right ventricular systolic pressure［J］. Echocardiography， 2021， 38（5）：760-766.
16	HERRERA C L， SCHELL R C， MCINTIRE D D， et al. Pulmonary hypertension complicating pregnancy： cardiac remodeling and residual concerns［J］. J Matern Fetal Neonatal Med， 2022， 35（21）：4104-4109.
17	CHIN K M， SANTIAGO-MUNOZ P. Pregnancy and Congenital Heart Disease-Associated Pulmonary Hypertension： Are Outcomes Improving？［J］ Circulation， 2023， 147（7）： 562-564.
18	LEY S， KAUCZOR H U， HEUSSEL C P， et al. Value of contrast-enhanced MR angiography and helical CT angiography in chronic thromboembolic pulmonary hypertension［J］. Eur Radiol， 2003， 13（10）： 2365-2371.
19	ZHAO H， ZHANG H， XU X， et al. Risk factors for perinatal cardiac complications inpregnancy with pulmonary hypertension［J］. Pregnancy Hypertens， 2018， 12： 207-213.
20	徐茁原，李强强，张陈，等. 先天性心脏病相关肺动脉高压患者死亡的危险因素及不同亚型的临床特点［J］. 中华心血管病杂志，2020，48（4）：315-322.
21	HEMNES A R， KIELY D G， COCKRILL B A， et al. Statement on pregnancy in pulmonary hypertension from the Pulmonary Vascular Research Institute［J］. Pulm Circ， 2015， 5（3）： 435-465.
22	胡思宇，金镇. 妊娠合并先天性心脏病伴肺动脉高压孕妇的母婴结局［J］. 中国医科大学学报，2022，51（7）：643-647.
23	LI Q， DIMOPOULOS K， LIU T， et al. Peripartum outcomes in a large population of women with pulmonary arterial hypertension associated with congenital heart disease［J］. Eur J Prev Cardiol， 2019， 26（10）： 1067-1076.
24	张君，逯伟达，李敏，等. 妊娠合并肺动脉高压患者剖宫产围产期并发症的危险因素分析［J］. 中华心血管病杂志，2022，50（1）：43-48.
25	ROSENKRANZ S， HOWARD L S， GOMBERG-MAITLAND M， et al. Systemic Consequences of Pulmonary Hypertension and Right-Sided Heart Failure［J］. Circulation， 2020， 141（8）： 678-693.
26	LV C， HUANG Y， LIAO G， et al. Pregnancy outcomes in women with pulmonary hypertension： a retrospective study in China［J］. BMC Pregnancy Childbirth， 2023， 23（1）： 16.
27	CHEN W， LUO J， CHEN J， et al. Effect of multidisciplinary team （MDT） centred on pregnant women with pulmonary hypertension on treatment and outcomes of pregnancy［J］. BMC Pulm Med， 2023， 23（1）： 62.
28	MA R， GAO H， CUI J， et al. Pregnancy feasibility in women with mild pulmonary arterial hypertension： a systematic review and meta-analysis［J］. BMC Pregnancy Childbirth， 2023， 23（1）： 427.
29	ZHANG L， QIE G， YIN X， et al. Pregnant outcomes of critically ill pregnant patients with pulmonary hypertension： A multicenter retrospective study［J］. Front Cardiovasc Med， 2022， 9： 872833.
30	ZHANG Q， ZHU F， SHI G， et al. Maternal Outcomes Among Pregnant Women With Congenital Heart Disease-Associated Pulmonary Hypertension ［J］. Circulation， 2023， 147（7）： 549-561.
31	DOLGUN Z N， INAN C， SAYIN N C. Maternal and fetal outcomes in pregnancies with pulmonary hypertension： Experience of a tertiary center［J］. Taiwan J Obstet Gynecol， 2018， 57（1）： 13-17.
32	CHEN Y， ZHOU D， XIONG M， et al. Prediction and prognosis of adverse maternal and foetal/neonatal outcomes in pulmonary hypertension： an observational study and nomogram construction ［J］. Respir Res， 2022， 23（1）： 314.
33	GERHARDT A， SCHARF R E， GREER I A， et al. Hereditary risk factors for thrombophilia and probability of venous thromboembolism during pregnancy and the puerperium［J］. Blood， 2016， 128（19）： 2343-2349.
34	REGITZ-ZAGROSEK V， ROOS-HESSELINK J W， BAUERSACHS J， et al. 2018 ESC Guidelines for the management of cardiovascular diseases during pregnancy［J］. Eur Heart J， 2018，39（34）：3165-3241.
35	张美玲，李亚蓉，王星语，等. 曲前列尼尔治疗妊娠合并先天性心脏病伴重度肺动脉高压1例报道［J］. 现代妇产科进展，2023，32（2）：159.
36	KHAN A， HUBEL K， BROOKFIELD K， et al. The use of selexipag， a prostacyclin receptor analog， for treatment of severe pulmonary artery hypertension during pregnancy， a case report［J］. Respir Med Case Rep， 2023， 45： 101895.
37	SITBON O， HUMBERt M， JAÏS X， et al. Long-term response to calcium channel blockers in idiopathic pulmonary arterial hypertension［J］. Circulation， 2005， 111（23）： 3105-3111.
38	WESTPHAL J G， OEHLER M， SCHULZE P C， et al. A case report of a 37-year-old woman with pulmonary arterial hypertension first presented during her 3rd pregnancy and favourable long-term vasoreactive response［J］. Eur Heart J Case Rep， 2022， 6（2）： ytac031.
39	陈乐，邱依聆，江燕萍，等. ECMO在危急重症心脏病孕产妇救治中的应用体会［J］. 实用医学杂志，2022，38（24）：3135-3140.
40	VAIDYA A， OLIVEROS E， MULLA W， et al. Management of Pulmonary Arterial Hypertension in Pregnancy： Experience from a Nationally Accredited Center［J］. J Cardiovasc Dev Dis， 2022， 9（6）： 195.
41	BOYERS S， NAYYAR R， MELOV S J， et al. A case series describing the multidisciplinary management of pulmonary arterial hypertension in pregnancy： Time for optimism［J］. Aust N Z J Obstet Gynaecol， 2023， 63（1）： 66-73.
42	DARAZ Y， MURTHY S， WOLFE D. Pregnancy in Pulmonary Arterial Hypertension： A Multidisciplinary Approach［J］. J Cardiovasc Dev Dis， 2022， 9（6）： 196.
43	RADVANSKY B M， SHAH R， FEINMAN J， et al. Pulmonary Hypertension in Pregnancy： A Positive Outcome with a Multidisciplinary Team and Individualized Treatment Plan［J］. J Cardiothorac Vasc Anesth， 2022， 36（8）： 3403-3413.
44	SHU T， FENG P， LIU X， et al. Multidisciplinary Team Managements and Clinical Outcomes in Patients With Pulmonary Arterial Hypertension During the Perinatal Period［J］. Front Cardiovasc Med， 2021， 8： 795765.
45	SU J Y， CHEN H F， WANG S M. Pregnancy outcome analysis of 94 patients with pulmonary arterial hypertension during pregnancy［J］. Eur Rev Med Pharmacol Sci， 2022， 26（6）： 1970-1977.
46	TOKGÖZ H C， AKBAL Ö Y， KARAGÖZ A， et al. Maternal and Fetal Outcomes in Pregnant Women with Pulmonary Arterial Hypertension： A Single-Center Experience and Review of Current Literature［J］. Anatol J Cardiol， 2022， 26（12）： 902-913.
47	OUZOUNIAN J G， ELKAYAM U. Physiologic changes during normal pregnancy and delivery［J］. Cardiol Clin， 2012， 30（3）： 317-329.
48	BEDARD E， DIMOPOULOS K， GATZOULIS M A. Has there been any progress made on pregnancy outcomes among women with pulmonary arterial hypertension？［J］. Eur Heart J， 2009， 30（3）： 256-265.
49	CORBACH N， BERLIER C， LICHTBLAU M， et al. Favorable Pregnancy Outcomes in Women With Well-Controlled Pulmonary Arterial Hypertension［J］. Front Med （Lausanne）， 2021， 8： 689764.
50	GUGLIELMINOTTI J， LANDAU R， LI G. Adverse Events and Factors Associated with Potentially Avoidable Use of General Anesthesia in Cesarean Deliveries［J］. Anesthesiology， 2019， 130（6）： 912-922.
51	TSUKINAGA A， YOSHITANI K， KUBOTA Y， et al. Anesthesia for cesarean section and postpartum cardiovascular events in congenital heart disease： A Retrospective Cohort Study［J］. J CardiothoracVascAnesth， 2021， 35（7）： 2108-2114.
52	MONAGLE J， MANIKAPPA S， INGRAM B， et al. Pulmonary hypertension and pregnancy： The experience of a tertiary institution over 15 years［J］. Ann Cardiac Anaesth， 2015， 18： 153-160.
53	潘丽峰，张殿红，董伟妍. 妊娠合并肺动脉高压产妇剖宫产术应用腰麻-硬膜外联合麻醉对血流动力学和母婴结局的影响［J］. 中国计划生育学杂志，2022，30（3）：587-591.
54	WANG Y， XU H， LI H， et al. Association of hemodynamics during caesarean section， outcomes after caesarean section and hormone changes with different anesthesia in pregnant women with severe pulmonary arterial hypertension［J］. Exp Ther Med， 2018， 15（6）： 4731-4736.
55	AFIFY H， KONG A， BERNAL J， et al. Pulmonary Hypertension in Pregnancy： Challenges and Solutions［J］. Integr Blood Press Control， 2022， 15： 33-41.
56	WANG T， LU J， LI Q， et al. Rapid Titration of Intravenous Treprostinil to Treat Severe Pulmonary Arterial Hypertension Postpartum： A Retrospective Observational Case Series Study［J］. Anesth Analg， 2019， 129（6）： 1607-1612.
57	BALLARD W， DIXON B， MCEVOY C A， et al. Pulmonary Arterial Hypertension in Pregnancy［J］. Cardiol Clin， 2021， 39（1）： 109-118.

[1]	Fei GAO,Jing LI,Hongjian. LI. MAPK improves intestional obstruction in pregnancy through inhibiting TLR4/Myd88/NF⁃κB pathway [J]. The Journal of Practical Medicine, 2024, 40(8): 1095-1100.
[2]	Yushi LIU,Qingmei LIN,Man HE,Yang SU,Yin YANG,Hualiang LIN,Zanyi CAI,Xiaoling. GUO. Maternal gestational diabetes， maternal weight gain during pregnancy， and feeding methods on neurodevelopmental delay in their offsprings [J]. The Journal of Practical Medicine, 2024, 40(8): 1108-1113.
[3]	Qingqing WANG,Jie DING,Haiwen LI,Zhijian DONG,Yiying WANG,Siqi LIU,Guoji CHANG,Lijuan HUA,Huayi CHEN,Shenghao LI,Yongrui. YANG. Analysis of factors influencing short⁃term adverse clinical outcome in cirrhotic patients with grade 2/3 ascites [J]. The Journal of Practical Medicine, 2024, 40(8): 1114-1120.
[4]	Biyun ZHANG,Xingming ZHONG,Xiaoxia WANG,Xiaohua. LIU. Relationship between endometrial lactobacillus⁃dominated microbiota and reproduction [J]. The Journal of Practical Medicine, 2024, 40(7): 898-903.
[5]	Zhixia TANG,Shuangying MA,Ying ZHAGN,Jiajia SHENG,Juan LI,Jingjing HE,Henghua XUAN,Mingyun. HONG. Role of complement C3 in early predicting pregnancy outcomes of frozen⁃thawed embryo transfer [J]. The Journal of Practical Medicine, 2024, 40(7): 924-929.
[6]	Xiaotong LIU,Xianhua SU,Zhijun XIN,Fengqiong GAO,Jiayi FENG,Tongxia. XIA. Risk factors of postoperative complications in patients with spinal tuberculosis and the predictive value of prognostic nutritional index [J]. The Journal of Practical Medicine, 2024, 40(7): 972-978.
[7]	Rong SHI,Xianfang ZHENG,Qun TAO,Junmo CHEN,Xiaohua GE. Effect of laparoscopic salpingectomy on ovarian reserve function and serum neuropeptide Y and cortisol in patients with ectopic pregnancy [J]. The Journal of Practical Medicine, 2024, 40(6): 801-806.
[8]	Changzhi GUO,Tao SUN,Shuman HAN,Lingxiang WANG,Mengjing. NIU. Risk factors of peripheral infections of knee joint tumor prosthesis and predictive value of serum D⁃dimer and TLR2 [J]. The Journal of Practical Medicine, 2024, 40(6): 814-819.
[9]	Xilin WANG,Chanjuan YANG,Daomeng. CHENG. Construction of a nomogram prediction model for aggressive behavior in patients with bipolar disorder [J]. The Journal of Practical Medicine, 2024, 40(5): 677-681.
[10]	Xi CHEN,Xinni WANG,Yuan QI,Shuxiang HU,Jin LI. Effect analysis of combined Tiaojingzhuyun mixture and regulating menstration and promoting pregnancy by thirteen acupuncture in treating infertility caused by Follicle dysplasia [J]. The Journal of Practical Medicine, 2024, 40(3): 412-416.
[11]	Huiqun WANG,Chao YE,Chao XU,Si CHEN,Kaiguang ZHANG,Mei. XIAO. A 5⁃year follow⁃up study of rebleeding after endoscopic treatment of esophageal gastric varices rebleeding associated with liver cirrhosis [J]. The Journal of Practical Medicine, 2024, 40(22): 3155-3159.
[12]	Shijun LUO,Lizi ZHANG,Dunjin. CHEN. Diagnosis， prevention and treatment of placenta accreta spectrum with non⁃traumatic factors [J]. The Journal of Practical Medicine, 2024, 40(21): 2971-2975.
[13]	Lili TANG,Xueming LI,Liming LEI,Xiaodong ZENG,Yun LING,Qiongyu LIN,Sumin. ZHU. Risk factors for prolonged ICU stay after surgery in patients with infective endocarditis [J]. The Journal of Practical Medicine, 2024, 40(20): 2854-2859.
[14]	Jia ZHEN,Ziyuan ZHAO,Wei SHI,Zilu WANG,Zhiyong LIU,Li XU. The mechanism and treatment progress of endometrial receptivity change in adenomyosis [J]. The Journal of Practical Medicine, 2024, 40(20): 2941-2948.
[15]	Xianghong CHEN,Xiumin CHEN,Yingyan ZHOU,Li LI,Zhenxiong. XU. Advancements in the investigation of cardiovascular risk associated with idiopathic inflammatory myopathy [J]. The Journal of Practical Medicine, 2024, 40(19): 2801-2805.

Progress in diagnosis and treatment of pregnancy complicated with pulmonary arterial hypertension

RichHTML

PDF (PC)

Knowledge

Abstract

Cite this article

share this article

References 57

Related Articles 15

Recommended Articles

Metrics

Comments