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      Catheter-Based Interventions for the Management of Valvular Heart Disease During Pregnancy

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      Author(s): , MD a , b , ∗ , , MD a , , MD a
      Publication date (Electronic):
      Journal: JACC: Advances
      Publisher: Elsevier
      Keywords: cardio-obstetrics, catheter-based interventions, pregnancy, valvular heart disease

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          Abstract

          Pregnancy is associated with a significant increase in hemodynamic burden. These changes can lead to maternal morbidity and mortality as well as unfavorable fetal outcomes in patients with valvular heart disease and limited cardiac reserve. Mechanical interventions may be needed for the management of severe hemodynamic deterioration not responding to medical therapy. Catheter-based percutaneous interventions can provide an alternative therapy to surgery during pregnancy. The purpose of this article is to review indications, potential advantages, and limitations of catheter-based interventions for the management of women with valvular heart disease in pregnancy.

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          Highlights

          • •

            Invasive interventions may be needed for the management of severe hemodynamic deterioration in pregnant women with valvular disease.

          • •

            Cardiac surgery during pregnancy is associated with high fetal loss and prosthetic valves with risk of complications and early deterioration.

          • •

            Catheter-based percutaneous interventions can provide an alternative therapy to surgery during pregnancy.

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            Discussions regarding decision-making and performance of catheter-based interventions should be undertaken by an experienced multidisciplinary cardio-obstetrics valve team.

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          Most cited references141

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          National, regional, and worldwide estimates of preterm birth rates in the year 2010 with time trends since 1990 for selected countries: a systematic analysis and implications.

          Hannah Blencowe, Simon Cousens, Mikkel Z Oestergaard … (2012)
          Preterm birth is the second largest direct cause of child deaths in children younger than 5 years. Yet, data regarding preterm birth (<37 completed weeks of gestation) are not routinely collected by UN agencies, and no systematic country estimates nor time trend analyses have been done. We report worldwide, regional, and national estimates of preterm birth rates for 184 countries in 2010 with time trends for selected countries, and provide a quantitative assessment of the uncertainty surrounding these estimates. We assessed various data sources according to prespecified inclusion criteria. National Registries (563 datapoints, 51 countries), Reproductive Health Surveys (13 datapoints, eight countries), and studies identified through systematic searches and unpublished data (162 datapoints, 40 countries) were included. 55 countries submitted additional data during WHO's country consultation process. For 13 countries with adequate quality and quantity of data, we estimated preterm birth rates using country-level loess regression for 2010. For 171 countries, two regional multilevel statistical models were developed to estimate preterm birth rates for 2010. We estimated time trends from 1990 to 2010 for 65 countries with reliable time trend data and more than 10,000 livebirths per year. We calculated uncertainty ranges for all countries. In 2010, an estimated 14·9 million babies (uncertainty range 12·3-18·1 million) were born preterm, 11·1% of all livebirths worldwide, ranging from about 5% in several European countries to 18% in some African countries. More than 60% of preterm babies were born in south Asia and sub-Saharan Africa, where 52% of the global livebirths occur. Preterm birth also affects rich countries, for example, USA has high rates and is one of the ten countries with the highest numbers of preterm births. Of the 65 countries with estimated time trends, only three (Croatia, Ecuador, and Estonia), had reduced preterm birth rates 1990-2010. The burden of preterm birth is substantial and is increasing in those regions with reliable data. Improved recording of all pregnancy outcomes and standard application of preterm definitions is important. We recommend the addition of a data-quality indicator of the per cent of all live preterm births that are under 28 weeks' gestation. Distinguishing preterm births that are spontaneous from those that are provider-initiated is important to monitor trends associated with increased caesarean sections. Rapid scale up of basic interventions could accelerate progress towards Millennium Development Goal 4 for child survival and beyond. Bill & Melinda Gates Foundation through grants to Child Health Epidemiology Reference Group (CHERG) and Save the Children's Saving Newborn Lives programme; March of Dimes; the Partnership for Maternal Newborn and Childe Health; and WHO, Department of Reproductive Health and Research. Copyright © 2012 Elsevier Ltd. All rights reserved.
          Article 0 comments Cited 770 times – based on 0 reviews     Review now
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            Transcatheter Mitral-Valve Repair in Patients with Heart Failure

            Gregg Stone, JoAnn Lindenfeld, William T. Abraham … (2018)
            Among patients with heart failure who have mitral regurgitation due to left ventricular dysfunction, the prognosis is poor. Transcatheter mitral-valve repair may improve their clinical outcomes.
            Article 0 comments Cited 586 times – based on 0 reviews     Review now
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              2018 ESC Guidelines for the management of cardiovascular diseases during pregnancy

              Iveta Mintale, Piotr Hoffman, Antoniu Octavian Petriş … (2018)
              Article 0 comments Cited 464 times – based on 0 reviews     Review now
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                Author and article information

                Contributors
                Uri Elkayam: @uelkayam
                Journal
                Journal ID (nlm-ta): JACC Adv
                Journal ID (iso-abbrev): JACC Adv
                Title: JACC: Advances
                Publisher: Elsevier
                ISSN (Electronic): 2772-963X
                Publication date PMC-release: 27 April 2022
                Publication date Collection: June 2022
                Publication date (Electronic): 27 April 2022
                Volume: 1
                Issue: 2
                Electronic Location Identifier: 100022
                Affiliations
                [a ]Division of Cardiology, Department of Medicine, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
                [b ]Department of Obstetrics and Gynecology, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
                Author notes
                [∗ ] Address for correspondence: Dr Uri Elkayam, Division of Cardiovascular Medicine, USC School of Medicine, 2020 Zonal Avenue, Room 331, Los Angeles, California 90033-1034, USA. elkayam@ 123456usc.edu @uelkayam
                Article
                Publisher Item ID: S2772-963X(22)00022-9 Publisher ID: 100022
                DOI: 10.1016/j.jacadv.2022.100022
                PMC ID: 11198064
                PubMed ID: 38939308
                SO-VID: 80ce5c70-5357-44cf-a9b3-755bcf28c670
                Copyright © © 2022 The Authors
                License:

                This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).

                History
                Date received : 24 January 2022
                Date revision received : 1 March 2022
                Date accepted : 9 March 2022
                Categories
                Subject: State-of-the-Art Review
                Subject: Cardio-Obstetrics

                Keywords: cardio-obstetrics,catheter-based interventions,pregnancy,valvular heart disease
                Data availability:
                Keywords: cardio-obstetrics, catheter-based interventions, pregnancy, valvular heart disease

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