Cardiac structural abnormalities: A population norm or a risk group during pregnancy, childbirth, postpartum and in newborn infants
Objective. To summarize and analyze the evidence-based data analyses of cardiac structural abnormalities (CSAs), their distribution in the population, including in women in the perinatal period and in neonates, and the role of CSAs in the risk of complications.Smolnova T.Yu., Nechaeva G.I., Martynov A.I., Bockeria E.L.
Material and methods. The review included data from foreign and Russian sources over the past 15 years.
Results. CSAs in pregnant women are more common than could be supposed. In healthy pregnant women, hemodynamically insignificant mitral valve prolapse was concurrent with patent foramen ovale in 7.8% of cases, with atrial and ventricular septal aneurysm in 5.9%, with additional chords of the left ventricle in 10.4%; with malformations of the aortic valve leaflets in 7.8%, with calcification of the mitral valve leaflets in 2.6%, and with the dilated aortic root in 1.1%.
Conclusion. The approach to managing patients with CSAs should be extremely careful in view of a high risk of complications. Complications, as well as current approaches to the definition and clinical relevance of these conditions are outlined. A separate role is given to the diagnosis of CSAs and to the role of executing Order No. 572-n in patients with CSAs in obstetrics and gynecology.
Keywords
cardiac malformations
pregnancy
valve prolapse
patent foramen ovale
Eustachian valve
thebesian valve
mitral valve
aortic valve
childbirth
postpartum period
risk
stroke
infarction
aneurysm
additional chords
Chiari network
References
1. Юдина О.А. Морфологическая и клиническая характеристика малых аномалий сердца: автореф. дисс. … канд. мед. наук. Минск; 2009. 26с. [Yudina O.A. Morphological and clinical characteristics of small heart anomalies: author’s abstract. Diss. Minsk; 2009. 26p. (in Russian)]
2. Рудой А.С., ред. Структурные аномалии сердца. Наднациональные (международные) рекомендации. Разработаны комитетом экспертов Евразийской ассоциации терапевтов, Белорусским научным обществом кардиологов и Российским научным медицинским обществом терапевтов. 2016.112с. [Rudoy A.S., ed. Structural anomalies of the heart. Supranational (international) recommendations. Developed by the expert committee of the Eurasian Association of Physicians, the Belarusian Scientific Society of Cardiology and the Russian Scientific Medical Society of Physicians. 2016.112p. (in Russian)]
3. Володин Н.Н., ред. Неонатология. Национальное руководство. М.: ГЭОТАР-Медиа; 2013. 887с. [Volodin N.N., ed. Neonatology. National guideline. Moscow: GEOTAR-Media; 2013. 887p. (in Russian)]
4. Orchard E.A., Wilson N., Ormerod O.J. The management of cryptogenic stroke in pregnancy. Obstet. Med. 2011; 4(1): 2-6. doi: 10.1258/om.2010.100027.
5. Carlin A., Alfirevic Z. Physiological changes of pregnancy and monitoring. Best Pract. Res. Clin. Obstet. Gynaecol. 2008; 22(5): 801-23. doi: 10.1016/j.bpobgyn.2008.06.005.
6. Pruetz J.D., Sklansky M., Detterich J., Korst L.M., Llanes A., Chmait R.H. Twin-twin transfusion syndrome treated with laser surgery: postnatal prevalence of congenital heart disease in surviving recipients and donors. Prenat. Diagn. 2011; 31(10): 973-7. doi: 10.1002/pd.2818.
7. Смольнова Т.Ю. Клинико-патогенетические аспекты опущения и выпадения внутренних половых органов и патологии структур тазового комплекса у женщин при дисплазии соединительной ткани. Тактика ведения: дисс. … д-ра мед. наук. М.; 2009. 240с. [Smolnova T.Yu. Clinico-pathogenetic aspects of the omission and prolapse of internal genital organs and pathology of pelvic complex structures in women with connective tissue dysplasia. Tactics of reference. Diss. Moscow; 2009. 240p. (in Russian)]
8. Bereczki D. Jr., Szegedi N., Szakбcs Z., Gubucz I., May Z. Cryptogenic postpartum stroke. Neurol. Neurochir. Pol. 2016; 50(5): 370-3. doi: 10.1016/j.pjnns.2016.05.001.
9. Guercini F., Acciarresi M., Agnelli G., Paciaroni M. Cryptogenic stroke: time to determine etiology. J. Thromb. Haemost. 2008; 6(4): 549-54. doi: 10.1111/j.1538-7836.2008.02903.
10. Palomeras Soler E., Fossas Felip P., Cano Orgaz A.T., Sanz Cartagena P Cryptogenic infarct. A follow-up period of 1 year study. Neurologia (Barcelona, Spain). 2009; 24(5): 304-8.
11. Chen L., Deng W., Palacios I., Inglessis-Azuaje I., McMullin D., Zhou D. et al. Patent foramen ovale (PFO), stroke and pregnancy. J. Investig. Med. 2016; 64(5): 992-1000. doi: 10.1136/jim-2016-000103.
12. Morjaria R., Tsaloumas M., Shah P. An unusual presentation of patent foramen ovale. JRSM Open. 2015; 6(8): 2054270415596320. doi: 10.1177/2054270415596320.
13. Sharma S., Sharma S.M., Cruess A.F., Brown G.C. Transthoracic echocardiography in young patients with acute retinal arterial obstruction. RECO Study Group. Retinal Emboli of Cardiac Origin Group. Can. J. Ophthalmol. 1997;32: 38-41.
14. Agostoni P., Gasparini G., Destro G. Acute myocardial infarction probably caused by paradoxical embolus in a pregnant woman. Heart. 2004;90(3): e12.
15. Toru S., Murata T., Ohara M., Ishiguro T., Kobayashi T. Paradoxical cerebral embolism with patent foramen ovale and deep venous thrombosis caused by a massive myoma uteri. Clin. Neurol. Neurosurg. 2013; 115(6): 760-1. doi: 10.1016/j.clineuro.2012.06.042.
16. Caputi L., Usai S., Carriero M.R., Grazzi L., D’Amico D., Falcone C. et al. Microembolic air load during contrast- transcranial Doppler: a trigger for migraine with aura? Headache. 2010; 50(8): 1320-7. doi: 10.1111/j.1526-4610.2010.01621.
17. Goel S.S., Tuzcu E.M., Shishehbor M.H., de Oliveira E.I., Borek P.P., Krasuski R.A. et al. Morphology of the patent foramen ovale in asymptomatic versus symptomatic (stroke or transient ischemic attack) patients. Am. J. Cardiol. 2009; 103(1): 124-9. doi: 10.1016/j.amjcard.2008.08.036.
18. Schneider B., Hofmann T., Justen M.H., Meinertz T. Chiari’s network: normal anatomic variant or risk factor for arterial embolic events? J. Am. Coll. Cardiol. 1995; 26(1): 203-10.
19. Klimek-Piotrowska W., Hołda M.K., Koziej M., Strona M. Anatomical barriers in the right atrium to the coronary sinus cannulation. PeerJ. 2016; 3: e1548. doi: 10.7717/peerj.1548.
20. Aypar E., Sert A., Odabaş D. Unusually prominent Chiari’s network prolapsing into the right ventricle in an asymptomatic newborn. Pediatr. Cardiol. 2013; 34(4): 1017-9. doi: 10.1007/s00246-012-0342-4.
21. Prajapat L., Ariyarajah V., Spodick D.H. Abnormal atrial depolarization associated with chiari network? Cardiology. 2007; 108: 214-6. doi: 10.1159/000096780.
22. Alegría-Barrero E., Alegría-Barrero A., Gavira Gómez J.J., Rábago Juan-Aracil G.Chiari’s network and paroxysmal atrial fibrillation. Rev. Esp. Cardiol. 2011; 64(8): 727-8. doi: 10.1016/j.rec.2010.11.003.
23. Maheshwari M., Kaushik S.K. Chiari network-induced paroxysmal atrial fibrillation. J Indian Acad. Clin. Med. 2014; 15(1): 47-8.
24. Алехин М.Н., Докина Е.Д. Эхокардиографическая диагностика сети Хиари. Ультразвуковая и функциональная диагностика. 2014; 5: 119-27. [Alekhin M.N., Dokina E.D. Echocardiographic diagnosis of the Chiari chain. Ultrazvukovaya i funktsionalnaya diagnostika. 2014; 5: 119-27. (in Russian)]
25. Yamashita T., Ohkawa S., Imai T., Ide H., Watanabe C. Prevalence and clinical significance of anomalous muscular band in the left atrium. Am. J. Cardiovasc. Pathol. 1993; 4(4): 286-93.
26. Rigatelli G., Dell’avvocata F., Cardaioli P., Giordan M., Braggion G., Aggio S. et al. Migraine-patent foramen ovale connection: role of prominent eustachian valve and large Chiari network in migrainous patients. Am. J. Med. Sci. 2008; 336(6): 458-61. doi: 10.1097/MAJ.0b013e31816e189d.
27. Asirdizer M., Tatlisumak E. The role of eustachian valve and patent foramen ovale in sudden death. J. Clin. Forensic Med. 2006; 13(5): 262-7. doi: 10.1016/j.jcfm.2005.11.009.
28. Gulel O., Yazici M., Sahin M. Unusual elongation of the Eustachian valve. Int. Heart J. 2007; 48(1): 113-6. doi: 10.1536/ihj.48.113.
29. Schmid E., Scheule A., Locke A., Rosenberger P. Echocardiographic-guided placement of venous cannula due to inferior vena cava obstruction through a large eustachian valve. Anesth. Analg. 2010; 111(1): 76-8. doi: 10.1213/ane.0b013e3181e05310.
30. Bonde P., Sachithanandan A., Graham A.N., Richardson S.G., Gladstone D.J. Right atrial myxoma arising from the Eustachian valve in a patient with colonic polyposis. J. Heart Valve Dis. 2002; 11(4): 601-2.
31. Shigemitsu O., Hadama T., Mori Y., Miyamoto S., Sako H., Uchida Y. Surgical treatment of right atrial papillary fibroelastoma, originated from the eustachian valve - a case report. Nippon Kyobu Geka Gakkai Zasshi. 1995; 43: 403-6.
32. Nkomo V.T., Miller F.A. Eustachian valve cyst. J. Am. Soc. Echocardiogr. 2001; 14(12): 1224-6.
33. Pellicelli A.M., Pino P., Terranova A., D’Ambrosio C., Soccorsi F. Eustachian valve endocarditis: a rare localization of right side endocarditis. A case report and review of the literature. Cardiovasc. Ultrasound. 2005; 3: 30.
34. San Roman J.A., Vilacosta I., Sarria C., Garcimartin I., Rollan M.J., Fernandez-Aviles F. Eustachian valve endocarditis: Is it worth searching for? Am. Heart J. 2001; 142(6): 1037-40.
35. Halimi F., Hidden-Lucet F., Tonet J., Fontaine G., Frank R. Radiofrequency catheter ablation of common atrial flutter: role of the eustachian valve. J. Interv. Card. Electrophysiol. 1999; 3: 169-72.
36. Nakagawa H., Lazzara R., Khastgir T., Beckman K.J., McClelland J.H., Imai S. et al. Role of the tricuspid annulus and the eustachian valve/ridge on atrial flutter. Relevance to catheter ablation of the septal isthmus and a new technique for rapid identification of ablationsuccess. Circulation. 1996; 94(3): 407-24. doi.org/10.1161/01.cir.94.3.407.
37. Земцовский Э.В., Малев Э.Г. Малые аномалии сердца и диспластические фенотипы. Монография. СПб.: Изд-во «ИВЭСЭП»; 2012. 160с. [Zemtsovsky E.V., Malev E.G. Small heart anomalies and dysplastic phenotypes. Monograph. St. Petersburg: Publishing house „IVESEP”; 2012. 160p. (in Russian)]
38. Жерко О.М. Малые аномалии сердца у детей. Учебно-методическое пособие. Минск: БелМАПО; 2007. 39с. [Zherko O.M. Small heart anomalies in children. Teaching-methodical manual. Minsk: BelMAPO; 2007. 39p. (in Russian)]
39. 3D echocardiography: the art of defining cardiac morphology. [Electronic resource]. Available at: http://www.3dechocardiography.com/Cortriatriatum_Dexter.html Accessd: 24.01.2016.
40. Jain A., Kumar R. Persistens Eusthachian valve in adults – a cadaveric study. Int. J. Basic Applied Med. Sci. 2013; 3(3): 132-7.
41. Agmon Y., Khandheria B.K., Meissner I., Gentile F., Whisnant J.P., Sicks J.D. et al. Frequency of atrial septal aneurysms in patients with cerebral ischemic events. Circulation. 1999; 99(15): 1942-4.
42. Overell J.R., Bone I., Lees K.R. Interatrial septal abnormalities and stroke A meta-analysis of case-control studies. Neurology. 2000;55(8): 1172-9.
43. Lamy C., Giannesini C., Zuber M., Arquizan C., Meder J.F., Trystram D. et al. Clinical and imaging findings in cryptogenic stroke patients with and without patent foramen ovale: the PFO-ASA Study. Stroke. 2002; 33(3):706-11.
44. Rahimtoola S.H. Presence of patent foramen ovale (PFO). Foreword. Curr. Probl. Cardiol. 2009; 34(10): 481.
45. Seiler C. How should we assess patent foramen ovale? Heart. 2004;90(11): 1245-7.
46. Sommer R.J., Hijazi Z.M., Rhodes J.F. Jr. Pathophysiology of congenital heart disease in the adult. Part I: Shunt lesions. Circulation. 2008;117(8): 1090-9.
47. Bakalli A., Kamberi L., Pllana E., Gashi A. Atrial septal aneurysm associated with additional cardiovascular comorbidities in two middle age female patients with ECG signs of right bundle branch block: two case reports. Cases J. 2008; 1(1): 51. doi.org/10.1186/1757-1626-1-51.
48. Papa M., Fragasso G., Camesasca C., Di Turi R.P., Spagnolo D., Valsecchi L. et al. Prevalence and prognosis of atrial septal aneurysm in high risk fetuses without structural heart defects. Ital. Heart J. 2002; 3(5): 318-21.
49. Bassareo P.P., Fanos V., Puddu M., Cadeddu C., Cadeddu F., Saba L. et al. High prevalence of interatrial septal aneurysm in young adults who were born preterm. J. Matern. Fetal Neonatal Med. 2014; 27(11): 1123-8. doi: 10.3109/14767058.2013.850667.
50. Малев Э.Г., Реева С.В., Тимофеев Е.В., Земцовский Э.В. Современные подходы к диагностике и оценке распространенности пролапса митрального клапана у лиц молодого возраста. Российский кардиологический журнал. 2010; 1: 35-41. [Malev E.G., Reeva S.V., Timofeev E.V., Zemtsovsky E.V. Modern approaches to the diagnosis and evaluation of the prevalence of mitral valve prolapse in young people. Russian Cardiology Journal. 2010; 1: 35-41. (in Russian)]
51. Freed L.A., Benjamin E.J., Levy D., Larson M.G., Evans J.C., Fuller D.L. et al. Mitral valve prolapse in the general population: the benign nature of echocardiographic features in the Framingham Heart Study. J. Am. Coll. Cardiol. 2002; 40(7): 1298-304.
52. Рудой А.С., Пашкевич П.П. Распространенность и актуальные вопросы военно-врачебной экспертизы пролапса митрального клапана. Военная медицина. 2011; 1: 36-41. [Rudoy A.S., Pashkevich P.P. Prevalence and topical issues of military-medical examination of mitral valve prolapse. Voennaya meditsina. 2011; 1: 36-41. (in Russian)]
53. Земцовский Э.В. Спортивная кардиология. СПб.: Гиппократ; 1995. 448с. [Zemtsovsky E.V. Sports cardiology. St. Petersburg: Hippocrates; 1995. 448p. (in Russian)]
54. Ribeiro C.L., Ginefra P., Albanesi Filho F.M., Christiani L.A., Quaresma J.C., Gomes Filho J.B. Prevalence of tricuspid and aortic valve prolapse in patients with mitral valve prolapse. Arq. Bras. Cardiol. 1989; 53(5): 251-5.
55. Keda T. Mitral valve prolapse in idiopathic ventricular tachycardia: Clinical and electrophysiologic characteristics. J. Cardiol. 1991; 21(3): 717-26.
56. Flack J.M., Kvasnicka J.H., Gardin J.M., Gidding S.S., Manolio T.A., Jacobs D.R. Jr. Anthropometric and physiologic correlates of mitral valve prolapse in a biethnic cohort of young adults: the CARDIA study. Am. Heart J. 1999; 138(3, Pt 1): 486-92.
57. Ягода А.В., Пруткова Н.А., Гладких Н.Н. Первичный пролапс митрального клапана у взрослых. Диагностика, вопросы диспансеризации и врачебной экспертизы. Учебное пособие. Ставрополь: СГМА; 2007. 72с. [Yagoda A.V., Prutkova N.A., Gladkikh N.N. Primary prolapse of the mitral valve in adults. Diagnosis, questions of medical examination and medical examination. Tutorial. Stavropol: SSMA; 2007. 72p. (in Russian)]
Received 16.06.2017
Accepted 23.06.2017
About the Authors
Smolnova Tatyana Yurievna, Doctor of Medicine, senior researcher of surgical department, Research Center of Obstetrics, Gynecology and Perinatology, Ministry of Health of Russia. 117997, Russia, Moscow, Ac. Oparina str. 4. Tel.: +74954384068. E-mail: smoltat@list.ru. Orcid.org/0000-0003-3543-651X. Scopus Author ID: 6504317244Nechaeva Galina Ivanovna, MD, professor, head of the Department of Internal Medicine and Family Medicine, Omsk State Medical University.
644099, Russia, Omsk, Lenina str. 12. Tel.: + 73812236700. E-mail: profnechaeva@yandex.ru
Martynov Anatoly Ivanovich, MD, Academician of the Russian Academy of Sciences, Professor of the Department of Hospital Therapy, senior researcher
of the Department of Operative Gynecology, A.I. Evdokimov Moscow State University of Medicine and Dentistry, Ministry of Health of Russia.
127473, Russia, Moscow, Delegatskaya str. 20/1. Tel.: +74956096700. E-mail: anatmartynov@mail.ru
Bokeria Ekaterina Leonidovna, MD, head of the department of pathology of newborns and prematurity No. 2, Research Center of Obstetrics, Gynecology and Perinatology, Ministry of Health of Russia. 117997, Russia, Moscow, Ac. Oparina str. 4. Tel.: +74954382620. E-mail: e_bokeriya@oparina4.ru
For citations: Smolnova T.Yu., Nechaeva G.I., Martynov A.I., Bockeria E.L. Cardiac structural abnormalities: A population norm or a risk group during pregnancy, childbirth, postpartum and in newborn infants. Akusherstvo i Ginekologiya/Obstetrics and Gynecology. 2018; (2): 5-12. (in Russian)
https://dx.doi.org/10.18565/aig.2018.2.5-12
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