背景:由于妊娠期的正常生理变化,妊娠期潜在心脏病的症状通常会被误认为是常见的主诉。对有心悸和呼吸困难症状的患者进行超声心动图评估可以发现结构变化并确定高危特征。
目的:该研究的目的是检查围产期个体心悸或呼吸困难的经胸超声心动图(TTE),以确定识别结构变化的频率。
方法:我们在2017年10月1日至2022年5月1日期间在一个学术中心对所有患有TTE的围产期个体进行了回顾性队列研究。超声心动图的指征,人口统计,并记录临床特征。对TTE报告中提到的任何异常发现的TTE进行了审查,并将其分类为先天性心脏病的发现。瓣膜疾病,心包积液,缺血/壁运动异常的证据,舒张/收缩功能异常,和其他。
结果:在我们对478名怀孕或产后12周的不同个体完成的539名TTE样本中,96例(17.8%)有心悸的指征,32例(5.9%)被列为呼吸困难的指征。在21.9%的心悸患者和34.4%的呼吸困难患者中发现了异常发现。在有心悸的患者中有异常的发现,33.3%患有先天性心脏病,33.3%有轻度瓣膜疾病,包括二尖瓣脱垂,19.0%有心包积液,14.3%的患者有缺血/室壁运动缺陷的证据.呼吸困难队列中的异常TTE结果包括缺血/壁运动缺陷(27.3%),轻度瓣膜疾病或二尖瓣脱垂(36.4%),收缩/舒张功能异常(36.4%)。
结论:许多患有呼吸困难或心悸的患者完成的TTE没有发现结构异常,然而,在大约三分之一到四分之一的患者中,发现了潜在的结构性心脏病。虽然其中一些异常不太可能改变分娩计划,如轻度瓣膜疾病或少量积液,其他如缺血,先天性异常,收缩/舒张功能异常可能对妊娠和产后管理有影响.
Symptoms of underlying cardiac disease in pregnancy can often be mistaken for common complaints because of normal physiological changes in pregnancy. Echocardiographic evaluation of patients with symptoms of palpitations and dyspnea can detect structural changes and identify high-risk features.
This study aimed to examine transthoracic
echocardiograms of perinatal individuals completed for palpitations or dyspnea to determine the frequency of identifying structural changes.
This was a retrospective cohort study of all perinatal individuals with a transthoracic echocardiogram at a single academic center between October 1, 2017, and May 1, 2022. The indication for the echocardiogram, demographics, and clinical characteristics were recorded. Transthoracic
echocardiograms with any abnormal findings noted in the transthoracic echocardiogram report were reviewed and categorized into findings of congenital heart disease, valvular disease, pericardial effusion, evidence of ischemia or wall motion abnormalities, abnormal diastolic or systolic function, and other.
Of 539 transthoracic
echocardiograms completed on 478 individuals who were pregnant or in the 12-week postpartum period, 96 (17.8%) had an indication of palpitations, and 32 (5.9%) had an indication of dyspnea. Abnormal findings were seen in 21.9% of patients with palpitations and in 34.4% of patients with dyspnea. In patients with palpitations who had abnormal findings, 33.3% had congenital heart disease; 33.3% had mild valvular disease, including mitral valve prolapse; 19.0% had a pericardial effusion; and 14.3% had evidence of ischemia or wall motion defects. Abnormal transthoracic echocardiogram findings in the dyspnea cohort included ischemia or wall motion defects (27.3%), mild valvular disease or mitral valve prolapse (36.4%), and abnormal systolic or diastolic function (36.4%).
Many of the transthoracic
echocardiograms completed for patients with dyspnea or palpitations identified no structural abnormality; however, in 1 of 3 to 1 of 4 patients, underlying structural heart disease was identified. Although some of these abnormalities were unlikely to change delivery plans, such as mild valvular disease or small effusions, other abnormalities, such as ischemia, congenital abnormalities, and abnormal systolic or diastolic function, were likely to have implications for pregnancy and postpartum management.