2021 年第 3 期 第 16 卷

主动脉瓣二叶畸形合并妊娠患者的临床特点及妊娠结局分析

Clinical characteristics and pregnancy outcomes in pregnant women with bicuspid aortic valves

作者：宋钰杨冬

英文作者：Song Yu Yang Dong

单位：首都医科大学附属北京安贞医院妇产科100029

英文单位：Department of Obstetrics and Gynecology Beijing Anzhen Hospital Capital Medical University Beijing 100029 China

关键词：妊娠；主动脉瓣二叶畸形；主动脉瓣狭窄；主动脉扩张

英文关键词：Pregnancy;Bicuspidaorticvalve;Aorticvalvestenosis;Aorticdilation

• 摘要：

• 目的 分析主动脉瓣二叶畸形（BAV）合并妊娠患者的临床特点及妊娠结局。方法 回顾性分析2011年2月至2020年1月于首都医科大学附属北京安贞医院参加产检的46例BAV合并妊娠患者的临床资料，根据病变类型分为主动脉瓣中重度狭窄组（26例）及主动脉扩张组（20例）。记录2组BAV诊断时间、不良妊娠结局比例及孕期情况。结果 46例患者中，28例孕前即诊断BAV，其余18例患者均为孕期首次诊断。主动脉瓣中重度狭窄组孕期纽约心脏病协会心功能分级Ⅲ~Ⅳ级、不良妊娠结局比例均高于主动脉扩张组［36.6%(9/26)比5.0%（1/20）、42.3%(11/26)比15.0%（3/20）］，差异均有统计学意义（均P＜0.05）。主动脉瓣中重度狭窄组主动脉瓣口面积（1.6±0.6）cm2，瓣膜峰值流速（3.5±1.0）m/s，平均瓣膜压力梯度（41±9）mmHg（1 mmHg=0.133 kPa）；15例孕期出现心脏疾病相关症状；2例行人工流产手术、1例经阴道分娩、23例行剖宫产手术终止妊娠；不良妊娠结局患者与良好妊娠结局患者年龄、体重指数比较，差异均无统计学意义（均P＞0.05）；不规律产检患者不良妊娠结局比例高于规律产检患者、主动脉瓣重度狭窄患者不良妊娠结局比例高于主动脉瓣中度狭窄患者，差异均有统计学意义（均P＜0.05）。主动脉扩张组主动脉内径（43.0±2.9）mm；4例孕期出现心脏疾病相关症状；1例经阴道分娩、19例行剖宫产手术终止妊娠；不良妊娠结局患者年龄高于良好妊娠结局患者（P＜0.05），但体重指数差异无统计学意义（P＞0.05）；不规律产检患者不良妊娠结局发生率高于规律产检患者，差异有统计学意义（P＜0.05）。结论 BAV合并妊娠患者中，主动脉瓣狭窄患者更容易出现不良妊娠结局。高龄可能影响主动脉扩张患者的妊娠结局。孕产妇对于BAV的认知及重视程度有待于宣教及加强。

• Objective To analyze clinical characteristics and pregnancy outcomes in pregnant women with bicuspid aortic valves (BAV). Methods From February 2011 to January 2020, clinical data of 46 pregnant women with BAV who participated prenatal examination in Beijing Anzhen Hospital, Capital Medical University were retrospectively analyzed. According to pathological types, they were divided into the moderate-severe aortic valve stenosis group (26 cases) and the aortic dilation group (20 cases). The diagnostic time of BAV, rate of adverse pregnancy outcomes and pregnancy circumstances in both groups were recorded. Results Among 46 cases， 28 cases were diagnosed as BAV before pregnancy, and the remaining 18 patients were all first diagnosed during pregnancy. The rates of New York Heart Association cardiac function grade Ⅲ-Ⅳ during pregnancy and  adverse pregnancy outcomes of the moderate-severe aortic valve stenosis group were higher than those of the aortic dilation group［36.6%(9/26) vs 5.0%（1/20）, 42.3%(11/26) vs 15.0%（3/20）］(both P<0.05). In the moderate-severe aortic valve atenosis group, aortic valve area was (1.6±0.6)cm2, valve peak flow rate was (3.5±1.0)m/s, and mean valvular pressure gradient was (41±9)mmHg; there were 15 cases with cardiac diseases correlated symptoms; there were 2 cases of artificial abortion surgery, 1 case of vaginal delivery, and 23 cases of cesarean section to terminate pregnancy; there were no significant differences in age and body mass index between patients with adverse pregnancy outcomes and patients with good pregnancy outcomes(both P>0.05); the rate of adverse pregnancy outcomes in patients with irregular birth tests was higher than that in patients with regular birth tests, and that in patients with severe aortic valve stenosis was higher than that in patients with moderate aortic valve stenosis (both P<0.05). In the aortic dilation group, the aortic diameter was (43.0±2.9)mm; there were 4 cases with cardiac diseases correlated symptoms; there were 1 case of vaginal delivery and 19 cases of cesarean section to  terminate pregnancy; the age in patients with adverse pregnancy outcomes was higher than that in patients with good pregnancy outcomes(P<0.05), but there was no significant difference in body mass index between the two kinds of patients(P>0.05); the rate of adverse pregnancy outcomes in patients with irregular birth tests was higher than that in patients with regular birth tests (P<0.05). Conclusions Among pregnant patients with BAV, patients with aortic valve stenosis are more likely to suffer adverse pregnancy outcomes. Advanced age may affect pregnancy outcome in patients with aortic dilation. The cognition and attention of pregnant women to BAV need to be publicized and strengthened.