Presentatie huisartsensymposium zwangerschap 2019 AVB final · 2019. 3. 29. · 2/2/19 2 2018 ESC...
Transcript of Presentatie huisartsensymposium zwangerschap 2019 AVB final · 2019. 3. 29. · 2/2/19 2 2018 ESC...
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2018 ESC Guidelines for the management of cardiovascular diseases during pregnancyEuropean Heart Journal (2018) 00, 1–83- doi:10.1093/eurheartj/ehy 340
www.escardio.org/guidelines
Zwangerschap en hartafwijkingen
An Van Berendoncks
2018 ESC Guidelines for the management of cardiovascular diseases during pregnancyEuropean Heart Journal (2018) 00, 1–83- doi:10.1093/eurheartj/ehy 340
www.escardio.org/guidelines
Belangrijkste oorzaken van moedersterfte
Lewis G (ed.). Saving Mothers’ Lives: reviewing maternal deaths to make motherhood safer—2006–2008. The Eighth Report of the ConfidentialEnquiries into Maternal Deaths in the United Kingdom. BJOG 2011;118(Suppl. 1):1–205.
MBRRACE-UK
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5
10
15
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25
1985-87
1988-90
1991-93
1994-96
1997-99
2000-02
2003-05
cardiac
Toename in moedersterfte tgvhartaandoening(deaths/1,000,000 maternities)
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2018 ESC Guidelines for the management of cardiovascular diseases during pregnancyEuropean Heart Journal (2018) 00, 1–83- doi:10.1093/eurheartj/ehy 340
www.escardio.org/guidelines
Belangrijkste cardiale oorzaken van moedersterfte
2018 ESC Guidelines for the management of cardiovascular diseases during pregnancyEuropean Heart Journal (2018) 00, 1–83- doi:10.1093/eurheartj/ehy 340
www.escardio.org/guidelines
Hoger risico tijdens zwangerschap?
Stijging in linker ventrikel massa en contractiliteit
50-65% stijging CO
20-30% stijging SV
15-30% stijging HF
30% daling SVR
+ 25% arbeid10% contracties
Hoger risico op hartfalen, ritmestoornissen, thrombose
en aorta dissectie tijdens zwangerschap
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2018 ESC Guidelines for the management of cardiovascular diseases during pregnancyEuropean Heart Journal (2018) 00, 1–83- doi:10.1093/eurheartj/ehy 340
www.escardio.org/guidelines
Risico
2.5-5% 6–10% 10-19% 19-27% 40-100%
% cardiale events moeder
Risico classificatie: mWHO
2018 ESC Guidelines for the management of cardiovascular diseases during pregnancyEuropean Heart Journal (2018) 00, 1–83- doi:10.1093/eurheartj/ehy 340
www.escardio.org/guidelines6
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2018 ESC Guidelines for the management of cardiovascular diseases during pregnancyEuropean Heart Journal (2018) 00, 1–83- doi:10.1093/eurheartj/ehy 340
www.escardio.org/guidelines7
mWHO IGeopereerde eenvoudige letsels
Milde pulmonaalstenose
mWHO II
mWHO II-III
mWHO III
Geopereerde tetralogie van Fallot
Supraventriculaire ritmestoornissen
Hypertrofe cardiomyopathie
Klepijden
Marfan zonder aorta dilatatie
mWHO IV
Mechanische kunstklep
LVEF 30-45%
Complexe congenitale hartziekten
Ernstige aorta dilatatie
LVEF < 30%
Pulmonale hypertensie
Ernstige symptomatische aortaklepstenose
2018 ESC Guidelines for the management of cardiovascular diseases during pregnancyEuropean Heart Journal (2018) 00, 1–83- doi:10.1093/eurheartj/ehy 340
www.escardio.org/guidelines8
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2018 ESC Guidelines for the management of cardiovascular diseases during pregnancyEuropean Heart Journal (2018) 00, 1–83- doi:10.1093/eurheartj/ehy 340
www.escardio.org/guidelines
•Consultatie voor de zwangerschap
Uitleg risico’s en verschillende opties
•Centralisatie van zorg voor alle vrouwen met een
(complexe) hartafwijking
•Behandeling door een multidisciplinair team met
digitaal vastleggen van alle afspraken.
Klinische implicaties
2018 ESC Guidelines for the management of cardiovascular diseases during pregnancyEuropean Heart Journal (2018) 00, 1–83- doi:10.1093/eurheartj/ehy 340
www.escardio.org/guidelines
UZA Pregnancy Heart Team
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An Vorlat Hilde Copejans Yves Jacquemyn
Joke Muys Veronique Van Reeth An Van Berendoncks
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2018 ESC Guidelines for the management of cardiovascular diseases during pregnancyEuropean Heart Journal (2018) 00, 1–83- doi:10.1093/eurheartj/ehy 340
www.escardio.org/guidelines11
Conclusies
Iedere vrouw met cardiale diagnose verdient extra aandacht voor
en tijdens de zwangerschap
Zelfs milde hartdefecten veroorzaken complicaties
Multidisciplinair team met vaste deelnemers