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The Critically Ill Pregnant ACHD Patient

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Intensive Care of the Adult with Congenital Heart Disease

Part of the book series: Congenital Heart Disease in Adolescents and Adults ((CHDAA))

Abstract

Increasing numbers of women with congenital heart disease (CHD) reach childbearing age. Therefore, pregnancies in these women are an emerging entity in the management of grown-up congenital heart disease (GUCH) or adult with congenital heart disease (ACHD). Pregnancy in women with CHD is associated with increased risks of cardiac, obstetric, and fetal adverse events and should therefore be discussed preferably before pregnancy. Individual risk assessments can be made using the modified World Health Organization classification and management should be performed accordingly. However, we do see a significant number of women with congenital heart disease who present being already pregnant, and sometimes the first presentation happens as an already critically ill patient. Cardiac emergencies like acute heart failure, arrhythmias, acute myocardial infarctions, or aortic dissections should be treated immediately but with consideration of the unique situation of pregnancy, taking into account not only the maternal outcome but also the effects on the fetus, which might introduce also ethical challenges. In this chapter, the treatment of the critically ill pregnant patient with CHD will be discussed, with special focus on specific high-risk conditions.

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References

  1. Knight M, Nair M, Tuffnell D, Kenyon S, Shakespeare J, Brocklehurst P, Kurinczuk JJ, editors. On behalf of MBRRACE-UK. Saving lives, improving mothers’ care—surveillance of maternal deaths in the UK 2012–14 and lessons learned to inform maternity care from the UK and Ireland Confidential Enquiries into Maternal Deaths and Morbidity 2009–14. Oxford: National Perinatal Epidemiology Unit, University of Oxford; 2016.

    Google Scholar 

  2. Balint OH, Siu SC, Mason J, Grewal J, Wald R, Oechslin EN, et al. Cardiac outcomes after pregnancy in women with congenital heart disease. Heart. 2010;96:1656–61.

    Article  Google Scholar 

  3. Lund CJ, Donovan JC. Blood volume during pregnancy. Significance of plasma and red cell volumes. Am J Obstet Gynecol. 1967;98:394.

    Article  CAS  Google Scholar 

  4. Katz R, Karliner JS, Resnik R. Effects of a natural volume overload state (pregnancy) on left ventricular performance in normal human subjects. Circulation. 1978;58:434.

    Article  CAS  Google Scholar 

  5. Capeless EL, Clapp JF. Cardiovascular changes in early phase of pregnancy. Am J Obstet Gynecol. 1989;161:1449.

    Article  CAS  Google Scholar 

  6. Steer PJ, editor. Heart disease and pregnancy. London: The Royal College of Obstetricians and Gynaecologists; 2006. ISBN: 1-04752-30-6

    Google Scholar 

  7. Van Hagen IM, Boersma E, Johnson MR, Thorne SA, Parsonage WA, Subías PE, et al. Global cardiac risk assessment in the Registry of Pregnancy and Cardiac disease: results of a registry from the European Society of Cardiology. Eur J Heart Fail. 2016;18:523–33.

    Article  Google Scholar 

  8. Thorne S, MacGregor A, Nelson-Piercy C. Risks of contraception and pregnancy in heart disease. Heart. 2006;92:1520–5.

    Article  Google Scholar 

  9. www.farmacotherapeutischkompas.nl

  10. Van Hagen IM, Cornette J, Johnson MR, Roos-Hesselink JW. Managing cardiac emergencies in pregnancy. Heart. 2016;0:1–15.

    Google Scholar 

  11. Ruys TPE, Roos-Hesselink JW, Hall R, Subirana-Domènech MT, Grando-Ting J, Estensen M, et al. Heart failure in pregnant women with cardiac disease: date from the ROPAC. Heart. 2014;100:231–8.

    Article  Google Scholar 

  12. 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;49:2303–11.

    Article  Google Scholar 

  13. Hilfiker-Kleiner D, Westhoff-Bleck M, Gunter HH, et al. A management algorithm for acute heart failure in pregnancy. The Hannover experience. Eur Heart J. 2015;36:769–70.

    Article  Google Scholar 

  14. McMurray JJ, Adamopoulos S, Anker SD, et al. ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure 2012: The Task Force for the Diagnosis and Treatment of Acute and Chronic Heart Failure 2012 of the European Society of Cardiology. Developed in collaboration with the Heart Failure Association (HFA) of the ESC. Eur Heart J. 2012;33:1787–847.

    Article  Google Scholar 

  15. Drenthen W, Pieper PG, Roos-Hesselink JW, van Lottum WA, Voors AA, Mulder BJ, et al. Pregnancy and delivery in women after Fontan pallitation. Heart. 2006;92:1290–4.

    Article  CAS  Google Scholar 

  16. Zentner D, Kotevski A, King I, Grigg L, d’Udekem Y. Fertility and pregnancy in the Fontan population. Int J Cardiol. 2016;208:97–101.

    Article  Google Scholar 

  17. Khan A, Kim YY. Pregnancy in complex CHD: focus on patients with Fontan circulation and patients with a systemic right ventricle. Cardiol Young. 2015;25:1608–14.

    Article  Google Scholar 

  18. Gouton M, Nizard J, Patel M, Sassolas F, Jimenez M, Radojevic J, et al. Maternal and fetal outcomes of pregnancy with fontan circulation: a multicentric observation study. Int J Cardiol. 2015;187:84–9.

    Article  Google Scholar 

  19. Canobbio MM, Morris CD, Graham TP, Landzberg MJ. Pregnancy outcomes after atrial repair for transposition of the great arteries. Am J Cardiol. 2006;98:668–72.

    Article  Google Scholar 

  20. Metz T, Jackson GM, Yetman AT. Pregnancy outcomes in women who have undergone an atrial switch repair for congenital d-transposition of the great arteries. Am J Obstet Gynecol. 2011;205:273.e1–5.

    Article  Google Scholar 

  21. Drenthen W, Pieper PG, Ploeg M, Voors AA, Roos-Hesselink JW, Mulder BJM, et al. Risk of complications during pregnancy after Senning or Mustard (atrial) repair of complete transposition of the great arteries. Eur Heart J. 2005;26:2588–95.

    Article  Google Scholar 

  22. Guedes A, Mercier LA, Leduc L, Berube L, Marcotte F, Dore A. Impact of pregnancy on the systemic right ventricle after a Mustard operation for transposition of the great arteries. JACC. 2004;44(2):433–7.

    Article  Google Scholar 

  23. Myerson SG, Mitchell AR, Ormerod OJ, Banning AP. What is the role of balloon dilatation for severe aortic stenosis during pregnancy? J Heart Valve Dis. 2005;14:147–50.

    PubMed  Google Scholar 

  24. Presbitero P, Boccuzzi GG, Oakley C. Percutaneous therapy. In: Oakley C, Warnes CA, editors. Heart disease in pregnancy (second edition). Oxford: Blackwell Publishing Group; 2007. p. 304–15.

    Chapter  Google Scholar 

  25. Regitz-Zagrosek V, Blomstrom Lundqvist CB, Borghi C, Cifkova R, Ferreira R, et al. ESC Guidelines on the management of cardiovascular diseases during pregnancy. The Task Force on the Management of Cardiovascular Diseases during Pregnancy of the European Society of Cardiology (ESC). Eur Heart J. 2011;32:3147–97.

    Article  Google Scholar 

  26. Roth A, Elkayam U. Acute myocardial infarction associated with pregnancy. J Am Coll Cardiol. 2008;52:171–80.

    Article  Google Scholar 

  27. Petitti DB, Sidney S, Quesenberry CP Jr, Bernstein A. Incidence of stroke and myocardial infarction in women of reproductive age. Stroke. 1997;28:280.

    Article  CAS  Google Scholar 

  28. Elkayam U, Jalnapurkar S, Barakkat MN, et al. Pregnancy-associated acute myocardial infarction: a review of contemporary experience in 150 cases between 2006 and 2011. Circulation. 2014;129:1695.

    Article  Google Scholar 

  29. Yip A, Saw J. Spontaneous coronary artery dissection: a review. Cardiovasc Diagn Ther. 2015;5:37–48.

    PubMed  PubMed Central  Google Scholar 

  30. Ismail S, Wong C, Rajan P, Vidovic MI. ST-elevation acute myocardial infarction in pregnancy: 2016 update. Clin Cardiol. 2017;40:399–406.

    Article  Google Scholar 

  31. Dürrleman N, Pellerin M, Bouchard D, et al. Prosthetic valve thrombosis: twenty-year experience at the Montreal Heart Institute. J Thorac Cardiovasc Surg. 2004;127:1388.

    Article  Google Scholar 

  32. Van Hagen IM, Roos-Hesselink JW, Ruys TPE, Merz WM, Goland S, Gabriel H, 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;132:132–42.

    Article  Google Scholar 

  33. Vahanian A, Alfieri O, Andreotti F, Antunes MJ, Barón-Esquivias G, Baumgartner H, et al. Guidelines on the management of valvular heart disease (version 2012) . The Joint Task Force on the Management of Valvular Heart Disease of the European Society of Cardiology (ESC) and the European Association for Cardio-Thoracic Surgery (EACTS). Eur Heart J. 2012;33:2451–96.

    Article  Google Scholar 

  34. Nishimura RA, Otto CM, Bonow RO, Ruiz CE, Carabello BA, Skubas NJ, 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;129:2440–92.

    Article  Google Scholar 

  35. Sliwa K, Van Hagen IM, Budts W, Swan L, Sinagra G, Caruana M, 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;18:1119–28.

    Article  Google Scholar 

  36. Tabarsi N, Levy R, Rychel V, Kiess M, Swinston J, Oakes J, Grewal J. Pregnancy among women with pulmonary arterial hypertension: a changing landschape? Int J Cardiol. 2014;177:490–1.

    Article  CAS  Google Scholar 

  37. Galie N, Humbert M, Vachiery JL, Gibbs S, Lang I, Torbicki A, et al. 2015 ESC/ERS Guidelines for the diagnosis and treatment of pulmonary hypertension: The Joint Task Force for the Diagnosis and Treatment of Pulmonary Hypertension of the European Society of Cardiology (ESC) and the European Respiratory Society (ERS): Endorsed by: Association of European Pediatric and Congenital Cardiology (AEPC), International Society for Heart and Lung Transplantation (ISHLT). Eur Heart J. 2016;37:67–119.

    Article  Google Scholar 

  38. Stewart FM. Marfan’s syndrome and other aortopathies in pregnancy. Obstet Med. 2013;6:112–9.

    Article  Google Scholar 

  39. Tromp CHN, Nanne ACM, Pernet PJM, Tukkie R, Bolte AC. Elektrical cardioversion during pregnancy: safe or not? Neth Hear J. 2011;19(3):134–6.

    Article  CAS  Google Scholar 

  40. Jeejeebhoy FM, Zelop CM, Lipman S, Carvalho B, Joglar J, Mhyre JM, et al. Cardiac arrest in pregnancy. a scientific statement from the American Heart Association. Circulation. 2015;132:1747–73.

    Article  Google Scholar 

  41. Agerstrand C, Abrams D, Biscotti M, Moroz L, Rosenzweig EB, D’Alton M, et al. Extracorporeal membrane oxygenation for cardiopulmonary failure during pregnancy and postpartum. Ann Thorac Surg. 2016;102:774–9.

    Article  Google Scholar 

  42. Ruys TPE, Roos-Hesselink JW, Pijuan-Domènech A, Vasario E, Gaisin IR, Lung B. Is a planned caesarean section in women with cardiac disease beneficial? Heart. 2015;101:530–6.

    Article  Google Scholar 

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Author information

Authors and Affiliations

  1. Department of Cardiology, Erasmus University, Rotterdam, The Netherlands

    Lucia Baris & Jolien W. Roos-Hesselink

Authors
  1. Lucia Baris
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  2. Jolien W. Roos-Hesselink
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Corresponding author

Correspondence to Jolien W. Roos-Hesselink .

Editor information

Editors and Affiliations

  1. Children’s Hospital Colorado, University of Colorado Denver, Aurora, CO, USA

    Eduardo da Cruz

  2. Pediatric Intensive Care, Royal Brompton & Harefield NHS Foundation Trust, London, UK

    Duncan Macrae

  3. Adult Congenital Heart Program, Heart Institute, Cincinnati Children Hospital Medical Center, Cincinnati, OH, USA

    Gary Webb

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Baris, L., Roos-Hesselink, J.W. (2019). The Critically Ill Pregnant ACHD Patient. In: da Cruz, E., Macrae, D., Webb, G. (eds) Intensive Care of the Adult with Congenital Heart Disease. Congenital Heart Disease in Adolescents and Adults. Springer, Cham. https://doi.org/10.1007/978-3-319-94171-4_18

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  • DOI: https://doi.org/10.1007/978-3-319-94171-4_18

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  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-94170-7

  • Online ISBN: 978-3-319-94171-4

  • eBook Packages: MedicineMedicine (R0)

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