Miscellaneous
This study was limited to women with mitral valve prolapse
associated with cardiac arrhythmias and/or valve incompetence,
the outcome of which depended on the degree of mitral
regurgitation and/or the presence and type of cardiac arrhythmias.
Our results were similar to a previous report document-
140
W. S. Avila et al.: Pregnancy and heart disease
ing an uneventful course of pregnancy in women with mitral
valve prolapse,31 except for one (0.2%) case of ruptured chordae
due to infective endocarditis.
Coronary arterial disease was infrequent (0.014%) and was
associated with cigarette smoking and oral contraceptive, findings
that are in agreement with the literature.32 Although no
deaths occurred in patients with coronary arterial disease,
almost half of them experienced some complications, including
unstable angina in 28.6% and congestive heart failure in
21.4%; these patients required intensive medical therapy and
eventually intervention procedures (percutaneous coronary
angioplasty in two cases, surgical myocardial revascularization
in one) to achieve a successful maternal outcome.
Pulmonary vascular disease was associated with complication
and mortality rates of 86 and 38%, respectively, data that
confirm an extreme risk of pregnancy in this setting. In addition,
in patients with pulmonary hypertension secondary to
schistosomiasis, maternal bleeding after delivery occurred in
two patients and hemorrhage due to ruptured esophageal
varices in another two. These observations are similar to the
study by Weiss and Hess33 that showed a maternal mortality of
56% for secondary pulmonary hypertension compared with
36% for primary pulmonary hypertension. These differences
were attributable to additional adverse factors such as hepatitis,
systemic connective tissue, or vascular inflammatory disease.
In spite of strict current management protocol, pulmonary
vascular disease is associated with an ominous maternal
prognosis, independent of the underlying cause,34 and pregnancy
is absolutely contraindicated in women with pulmonary
vascular disease.