简介：Thispaperreviewscurrentrecommendationsontheappropriateevaluationandmanagementofcardiacarrhythmiasinthepregnantpatient.Mostarrhythmiasduringpregnancyarebenignandrequirenointervention.Whenrequired,thedecisiontotreatshouldbebasedonsymptomseverityandtheassociatedrisktomotherandfetusposedbypotentiallyrecurringarrhythmiaepisodesthroughoutthepregnancy.Anytreatmentstrategyinthispatientpopulationhasinherentrisktobothmotherandunbornchild.Beforetheinitiationofanyintervention,documentationofaclinicalarrhythmiaandcorrelationwithclinicalsymptomsshouldbeobtained.Thereisnoroleforempirictherapy.

简介：Managementofrheumaticmitralregurgitationinawomancontemplatingpregnancypresentsuniquechallengesfortheclinician.Whentaskedwithtakingcareofthistypeofpatient,attentionneedstobepaidtothepatient’sfunctionalstatustodetermineifsymptomsarepresent.Inadditiontothisclinicalassessment,transthoracicechocardiographyisalsocritical.Itprovidesinsightintotheetiologyofthemitralregurgitation,assessesforthepresenceofconcomitantmitralstenosisorothervalvularabnormalities,characterizestheseverityofmitralregurgitationthroughanintegrativeapproachandidentifieshighriskfindingsincludingprogressiveleftventricular(LV)dilationandLVdysfunction.SurgicalinterventionisrecommendedforsymptomaticpatientsandinasymptomaticpatientswithevidenceofprogressiveLVdilationandaLVejectionfractionoflessthan60%.Whilethepresenceofpulmonaryhypertensionandatrialfibrillationhavebeenshowntoberiskfactorsindegenerativemitralregurgitation,thesamehasnotbeendemonstratedinrheumaticmitralvalvedisease.Whilemitralregurgitationmaybereasonablywelltoleratedduringpregnancy,symptomaticpatientsareathigherriskforadversematernalandfetaloutcomes,andtherefore,itisrecommendedthatmitralvalvesurgerybeperformedpriortopregnancy.Oncethedecisionhasbeenmadetoproceedtosurgery,mitralrepair,performedataHeartValveCenterofExcellenceisrecommendedifpossibleduetoimprovedoutcomes.Mitralvalverepairispossiblein>80%casesofrheumaticmitralregurgitation.Ifrepairisnotpossible,replacementwitheitherabioprostheticormechanicalvalvearereasonableoptions.Thereareadvantagesanddisadvantagestoeachapproachandthechoiceofprosthesisshouldbeashareddecisionbetweenthepatientandhertreatmentteam.

简介：Cardiovasculardiseaseistheleadingcauseofpregnancy-relateddeathsintheUnitedStates[1].Anestimated4%ofallpregnanciesintheUnitedStatesareaffectedbymaternalcardiovasculardisease,with80%ofthesecasesattributedtocongenitalheartdisease(CHD)[2–4].SecondarytoimproveddiagnosisandmanagementofCHD,morewomenwithCHDarereachingreproductiveage,andmanyofthesewomendesirepregnancy.WhilemanypregnantwomenwithCHDwillhaveanuncomplicatedpregnancyanddelivery,somewithmorecomplexcardiaclesionsorcomorbiditieswillhaveanincreasedriskofmaternalandneonatalmorbidityanddeath.Individualizedpreconception,antepartum,intrapartum.

简介：Peripartumcardiomyopathy(PPCM)isadisorderinwhichheartfailuredevelopsinthelastmonthofpregnancyorwithinthefirstfivemonthspostpartum.Theexactetiologyisnotknownalthoughrecentstudiessuggestangiogenicimbalanceisakeyfactorwithsolublefms-liketyrosinekinase-1(sFlt1)andacleavedformofprolactinpossiblyplayingimportantroles.Thisreviewdiscussestheepidemiology,riskfactors,diagnosis,treatmentandprognosisofPPCMandhighlightsrecentadvancesinourunderstandingofthisdisorder.

简介：ObjectivesPercutaneousballoonmitralvalvuloplasty(PBMV)isonewaytoimprovetherheumaticmitralstenosis.Howdoestheprocedureworkingravidaandfetusisnotveryclear.WeanalyzedtheeffectsandsafetyofPBMVoperationonpregnantpatientswithsevererheumaticmitralstenosis.MethodsEightpregnantpatientssufferingfromseveremitralstenosisunderwentfacilitatedPBMVoperationwithInoueballoon,andwerefollowedupfor(2.0±1.1)years.Contentsincludedoutcomeofpregnancy,infantgrowth,hemodynamics,echocardiography,cardiacfunction,mitralvalvesreplacementorrepeatvalvuloplasty.ResultsMitralvalvearea(MVA)before,oneweekandoneyearafterfacilitatedPBMVwere(0.84±0.21)cm2,(1.69±0.23)cm2and(1.51±0.24)cm2respectively.Thetransmitralpressuregradientdroppedfrom(22.1±4.7)mmHgto(9.9±3.1)mmHg(P<0.001)(1mmHg=0.133kPa).AfterfacilitatedPBMV,allpatientsshowedremarkableimmediatesymptomaticandhemodynamicimprovementwithoutseveremitralregurgitation.AllofthesepatientscouldmaintainNewYorkheartassociation(NYHA)ⅠorⅡfor(2.0±1.1)yearsaftertheoperation.TwopatientsdemandedinducedabortionconcerningabouttheteratogeniceffectofX-rayonfetus.Alltheothersixpatientscontinuedtheirgestationandhadfull-termcesareansectionwithoutcomplications.Theirnewbornsdevelopedhealthyandnormallytillnow.ConclusionsFacilitatedPBMVisafeasible,safeandeffectivedeviceforselectedpregnantpatientswithmitralstenosis.Theoperationiswelltoleratedbythefetus.

简介：BackgroundAcuterespiratorydistresssyndrome(ARDS)causedbyH7N9influenzainpregnantwomanisalife-threateningeventwithanincreasedriskformaternalandbaby'sdeath.Theaimofthisstudywastoevaluatetheimpactofpoint-of-careultrasonography(POCUS)onthemanagementandprognosisofthesepatients.MethodsAcaseof31-yr-oldpregnantwomaninourhospital,whowasunderwentPOCUSforevaluatingcardiopulmonaryfunctions,volumestate,fluidresponsivenessandultrasound-guidedprocedureswasadmittedtoIntensiveCareUnit(ICU).Weperformedultrasonographydailyformonitoringorganfunctions.Reviewofrelatedliteratureswasalsoconducted.ResultsWiththehelpofPOCUS,wemadequicklydiagnosisofseverepneumoniaandARDScausedbyH7N9influenza.ThetherapieshadalsobeenchangedafterPOCUSexaminations,suchasrestrictfluidadministrationrelyingontheassessmentsoftheinferiorvenacava(IVC)toestimatepreloadandlungultrasoundmonitoringtoidentifytheearlypresenceofextravascularlungwater(EVLW)andavoidfluidoverresuscitation,ultrasound-guidedrecruitmentmaneuvertoimprovedrespiratorydistresssyndrome,andsoon.ConclusionsPOCUShasasignificantimpactondecision-makingandtherapeuticmanagementandshouldbecomeaclinicalroutineinthemanagementofARDSpatientscausedbyH7N9influenzainpregnancy.