Features of diagnosis of pathology of the heart and main vessels in pregnant women. Experience of the national multidisciplinary team

Abstract

Features of diagnosis of the cardiovascular system in a pregnant or parturient woman affect the correct choice of strategy for their medical care. Examination of a woman with pathology of the heart and great vessels at the gravidity stage requires comprehensive support of the pregnancy heart team with the obligatory involvement of specialists in a particular pathology. The paper presents the vision of the National Team of Obstetric Cardiology and Cardiac Surgery for diagnostic algorithms for different types of cardiac pathology in pregnant women. The advantages of certain methods of examination of pregnant women with pathology of the heart and main vessels, as well as limitations and precautions performing certain instrumental imaging techniques during pregnancy are discussed. The specificity of diagnostics during pregnancy, presented in this paper, is based on current recommendations of the European Society of Cardiology, a few studies by individual authors and the own experience of members of a multidisciplinary team operating on the basis of two academic institutions — M.M. Amosov National Institute of Cardiovascular Surgery (ANICVS) and the Institute of Pediatrics, Obstetrics and Gynecology named by O.M. Lukyanova. The paper presents 7.5 years of experience in such cooperation. An expert screening examination of the cardiovascular system was performed on 2818 patients (4448 visits), 162 of whom required specialized examination and treatment at the ANICVS during the period from December 2013 to April 2021. Due developed and implemented diagnostic program both at the outpatient and inpatient stages of medical care for pregnant and parturient women with severe cardiac pathology, as well as coordinated and professional work of members of the multidisciplinary team, the survival rate in this complex group of patients was 97.3% among pregnant and parturient women and 93.3% among babies. The research was carried out in accordance with the principles of the Helsinki declaration. The study protocol was approved by the Local Ethics Committee of an participating institution. The informed consent of the patient was obtained for conducting the studies. No conflict of interest was declared by the authors. Key words: pregnancy, cardiac pathology, features of diagnostic algorithm, risk stratification.