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近廿年来,随着心血管外科的开展,大大改善了先天性心血管病的预后,不少先心病患者的病灶经过手术后,能够得到妊娠和分娩的机会,另一方面,由于抗生素的应用,风湿热并发心脏病的发生率比过去下降。这样,先心病在产科的重要性也逐渐突出。上海九所医院1975～1984年十年内的统计资料表明,前五年与后五年相比,风心病的比例在下降(前五年时占心脏病孕妇总数的45.2％,后五年下降为27.3%),而先心脏的比例在上升(34.2％上升为37.7％)。一般来说,既然先心病患者已能生存到生育年龄者,说明病情不太严重;但妊娠合并紫绀型先心病,尤其合并肺动脉高压者,预后很差。至于胎儿方面,大致与其他类型心脏病时相似,但先心病孕妇的胎儿发生先心病的机会要比心脏健康孕妇的胎儿增加三倍。妊娠合并先心病可分为二大类:无紫绀型和紫绀型。妊娠合并无紫绀型先心病这类孕妇心血管病变处并没有血液分流,或只有左至右的分流,即静脉和肺循环之间无异常的通路。 (一)房间隔缺损:由于左心房压力高于右心房,房间隔缺损处有左至右分流,右心房的负担增加,肺循环血流量增加,大多数病人能适应这两方面的增加,而不致发生肺动脉高压。 (二)室间隔缺损:缺口大者,一般都在成年前死亡。如缺损并不大,分流量少,大多数孕妇都能耐受妊娠所引起的血液动力学的改变。
Nearly 20 years, with the cardiovascular surgery, greatly improved the prognosis of congenital cardiovascular disease, many patients with congenital heart lesions after surgery, can be pregnant and childbirth opportunities, on the other hand, due to the application of antibiotics , The incidence of rheumatic fever complicated by heart disease than in the past decreased. In this way, the importance of obstetrics in congenital heart disease is also gradually prominent. Statistics from the nine hospitals in Shanghai in the ten years from 1975 to 1984 show that the proportion of rheumatic heart disease is declining in the first five years compared with the latter five years (45.2% of the total number of pregnant women with heart disease in the first five years and declining to 27.3%), while the proportion of the first heart increased (34.2% to 37.7%). In general, since patients with congenital heart disease have been able to survive until the childbearing age, indicating that the condition is not too serious; but pregnancy complicated with cyanotic congenital heart disease, especially with pulmonary hypertension, the prognosis is poor. As for the fetus, which is roughly similar to that of other types of heart disease, fetuses with congenital heart disease have a threefold greater chance of developing congenital heart disease than fetuses with heart-healthy pregnancies. Pregnancy with congenital heart disease can be divided into two categories: no cyanosis and cyanosis. Pregnancy with cyanotic congenital heart disease such cardiovascular disease in pregnant women and no blood diversion, or only left to right shunt, that is, no abnormal path between the vein and pulmonary circulation. (A) atrial septal defect: Since the left atrial pressure is higher than the right atrium, atrial septal defect left to right shunt, the burden of the right atrium, pulmonary blood flow increased, most patients can adapt to these two increases, not Pulmonary hypertension occurs. (B) ventricular septal defect: the big gap, usually died before adulthood. If the defect is not large, shunt less, most pregnant women are able to tolerate the hemodynamic changes caused by pregnancy.