妊娠合并大动脉转位11例临床分析

摘要

Objective:To analyze the management and outcome of pregnant woman with transposition of great arteries and to investigate the effect of multidisciplinary management during pregnancy on the pregnancy outcome.Methods:The clinical data of 11 pregnant women with transposition of great arteries under going treatment in Beijing Anzhen Hospital during January 2007 and December 2017 was studied retrospectively.The cardiac function, cardiac index, management during pregnancy and outcomes were assessed.Results:Eight patients (No.1～No.8) were complicated with corrected transposition of the great arteries (CTGA).one (No.9) was complicated with complete transposition of the great arteries (TGA).Two were complicated with double outlet right ventricle (DORV).Enlargement of left atrial enlargement and increase of left functional ventricular diameter were observed in all eight patients with CTGA.The left atrioventricular valve regurgitation was reported in these patients except the patient No.7 who had a mechanical valve replacement.Three cases had elevated BNP.Patient No.9 who was with TGA showed an enlargement of the right heart and a narrow inner diameter of left heart.Fetal death occurred in second trimester.The left ventricular enlargement, BNP elevation and atrioventricular valve regurgitation were observed in the two patients with DORV.The mean pregnancy length was 34.6±5.0 weeks.Nine had cesarean deliveries.One received cesarean section with fetal death.One had vaginal delivery.Average hemorrahge volume was 245±110 ml.One was fetal loss with cesarean section, while six were term delivery, and the other four cases were premature delivery.All eleven patients were discharges with an average hospitalization days 9.4±4.2 days.The average weight of fetus was 2659±1012 g.Three were low birth weight infants.Two newborns had mild asphyxia.No birth defects or fetal complications were reported.Conclusions:Pregnancy could be attempted in CTGA patients with normal cardiac function, no obvious cardiac valve regurgitation orventricular enlargement.They should be followed by multidisciplinary management during pregnancy.It is pregnancy contraindication for woman with TGA and DORV without surgical treatment.%目的:分析妊娠合并大动脉转位患者的孕期管理、妊娠结局, 探讨多学科综合管理对妊娠合并大动脉转位患者妊娠结局的影响.方法:回顾性分析2007年1月至2017年12月首都医科大学附属北京安贞医院妇产科收治的11例妊娠合并大动脉转位患者的孕期心功能、心脏指标、孕期管理及母儿结局等临床资料.结果:8例患者为矫正型大动脉转位 (CTGA), 1例患者为完全型大动脉转位 (TGA), 2例患者为右心室双出口 (DORV) .8例CTGA患者均出现左心房增大、功能左室 (解剖右室) 内径增大, 除1例机械瓣膜置换术后患者外, 均出现左房室瓣返流情况, 3例出现B型尿钠肽 (BNP) 升高.1例TGA患者出现右心增大、瓣膜返流, 孕中期发现胎死宫内.2例DORV患者均出现左室增大、BNP升高、瓣膜返流.11例患者中, 平均分娩孕周为34.6±5.0周, 9例行子宫下段剖宫产术, 1例行剖宫取胎术, 1例自然分娩, 术中平均出血量为245±110 ml.孕中期胎死宫内剖宫取胎1例, 足月产6例, 早产4例.11例患者均好转出院, 平均住院时间9.4±4.2天.新生儿平均出生体质量2659±1012 g, 低体质量儿3例, 新生儿轻度窒息2例.随访10例新生儿均无畸形、并发症.结论:心功能正常、心脏无明显瓣膜返流及心室增大的CTGA患者, 可以尝试妊娠, 孕期应由多学科综合评估、管理.未经手术矫正的TGA和DORV患者, 为妊娠禁忌证.