2018 ESC Guidelines for the management of cardiovascular diseases during pregnancy

Regitz‐Zagrosek, Vera; Roos‐Hesselink, Jolien W.; Bauersachs, J.; Blomström‐Lundqvist, Carina; Cífková, Renata; Bonis, Michele De; Iung, Bernard; Johnson, Mark; Kintscher, Ulrich; Kranke, Peter; Lang, IJ; Morais, João; Pieper, Petronella G.; Presbitero, Patrizia; Price, Susan; Rosano, Guiseppe; Seeland, Ute; Simoncini, T.; Swan, Lorna; Warnes, CA

doi:10.5603/kp.2019.0049

Cited by 158 publications

(268 citation statements)

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“…The current guidelines recommend management in the form of preconceptual counseling, risk stratification and a range of diagnostic/treatment options. Should a woman fall pregnant before this opportunity for proper assessment, risk stratification is still required to be able to manage the woman and Fetus most effectively, ethically and safely …”

Section: Current Guidelinesmentioning

confidence: 99%

“…The most recent European and United States guidelines offer limited guidance surrounding percutaneous or surgical management of aortic valvulopathy during pregnancy. The specific recommendations are summarized in Table .…”

Section: Current Guidelinesmentioning

confidence: 99%

“…Ideally, women with cardiovascular disease are assessed preconception to allow the most informed choices about that patient's management. This includes echocardiography to properly assess factors such as the type of valvulopathy and its severity, flow dependent indices, valve area and left ventricular function; these factors are used to characterize the disease and any hemodynamic consequences it has already caused . Exercise tolerance testing is also used to provide a prepregnancy status .…”

Section: Risk Stratificationmentioning

confidence: 99%

“…This includes echocardiography to properly assess factors such as the type of valvulopathy and its severity, flow dependent indices, valve area and left ventricular function; these factors are used to characterize the disease and any hemodynamic consequences it has already caused . Exercise tolerance testing is also used to provide a prepregnancy status . The aortic diameter is also assessed, as patients with prepregnancy aortic dilatation may be at risk of further dilatation .…”

Section: Risk Stratificationmentioning

confidence: 99%

“…Exercise tolerance testing is also used to provide a prepregnancy status . The aortic diameter is also assessed, as patients with prepregnancy aortic dilatation may be at risk of further dilatation . These give an idea of the extent of the disease and may assist in picking up any potential adverse outcomes for both mother and Fetus.…”

Section: Risk Stratificationmentioning

confidence: 99%

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Management of aortic valve disease during pregnancy: A review

et al. 2019

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Cardiovascular disease represents a significant portion of pregnancy‐related complications and is associated with high rates of morbidity and mortality in this cohort. Cardiac valvulopathy, and aortic valve pathologies, in particular, pose a significant challenge to women who are pregnant and to the health care professionals who look after them. Depending on the type and severity of aortic valve pathology, pregnancy may exacerbate or accelerate the progression of valvulopathy sequelae because of the hemodynamic changes that occur from conception, throughout gestation, up to Labor and postpartum. Management of such patients ranges from basic conservative measures such as bed‐rest, extending to high‐risk emergency open heart surgery. This nonstructured review aims to highlight the current evidence available relating to the management of aortic valve disease in pregnancy, with a key focus on cases which requires intervention beyond that of medical therapy. In conclusion, the management of aortic valvulopathy in pregnancy is a challenging field with only a small amount of clinical experience and retrospective study supporting evidence‐based decisions in this field. A greater understanding of the most recent advances is recommended to support decision making in this specialist field of clinical medicine.

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Section: Current Guidelinesmentioning

confidence: 99%

Section: Current Guidelinesmentioning

confidence: 99%

Section: Risk Stratificationmentioning

confidence: 99%

Section: Risk Stratificationmentioning

confidence: 99%

Section: Risk Stratificationmentioning

confidence: 99%

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Management of aortic valve disease during pregnancy: A review

et al. 2019

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Clinical Features and Outcomes of Pregnancy-Related Acute Aortic Dissection

et al. 2020

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Antithrombotic and anticoagulation therapies in cardiogenic shock: a critical review of the published literature

et al. 2021

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Cardiogenic shock (CS) is a complex multifactorial clinical syndrome, developing as a continuum, and progressing from the initial insult (underlying cause) to the subsequent occurrence of organ failure and death. There is a large phenotypic variability in CS, as a result of the diverse aetiologies, pathogenetic mechanisms, haemodynamics, and stages of severity. Although early revascularization remains the most important intervention for CS in settings of acute myocardial infarction, the administration of timely and effective antithrombotic therapy is critical to improving outcomes in these patients. In addition, other clinical settings or non‐acute myocardial infarction aetiologies, associated with high thrombotic risk, may require specific regimens of short‐term or long‐term antithrombotic therapy. In CS, altered tissue perfusion, inflammation, and multi‐organ dysfunction induce unpredictable alterations to antithrombotic drugs' pharmacokinetics and pharmacodynamics. Other interventions used in the management of CS, such as mechanical circulatory support, renal replacement therapies, or targeted temperature management, influence both thrombotic and bleeding risks and may require specific antithrombotic strategies. In order to optimize safety and efficacy of these therapies in CS, antithrombotic management should be more adapted to CS clinical scenario or specific device, with individualized antithrombotic regimens in terms of type of treatment, dose, and duration. In addition, patients with CS require a close and appropriate monitoring of antithrombotic therapies to safely balance the increased risk of bleeding and thrombosis.

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2018 ESC Guidelines for the management of cardiovascular diseases during pregnancy

Abstract: Wytyczne ESC dotyczące postępowania w chorobach układu sercowo-naczyniowego podczas ciąży (2018) Grupa Robocza Europejskiego Towarzystwa Kardiologicznego ds. postępowania w chorobach układu sercowo-naczyniowego podczas ciąży

Cited by 158 publications

References 0 publications

Management of aortic valve disease during pregnancy: A review

Management of aortic valve disease during pregnancy: A review

Clinical Features and Outcomes of Pregnancy-Related Acute Aortic Dissection

Antithrombotic and anticoagulation therapies in cardiogenic shock: a critical review of the published literature

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