p.2 抽出テキスト

.........................................................................

Document Reviewers: Christi Deaton (CPG Review Coordinator) (UK), Iain A. Simpson (CPG Review Coordinator) (UK), Victor Aboyans (France), Stefan Agewall (Norway), Emanuele Barbato (Italy), Pavel Calda2 (Czech Republic), Antonio Coca (Spain), Ioan Mircea Coman (Romania), Julie De Backer (Belgium), Victoria Delgado (The Netherlands), Giovanni Di Salvo (UK), Samantha Fitzsimmons (UK), Donna Fitzsimons (UK), Madalina Garbi (UK), Sofie Gevaert (Belgium), Gerhard Hindricks (Germany), Guillaume Jondeau (France), Jolanda Kluin (The Netherlands), Christos Lionis (Greece), Theresa A. McDonagh (UK), Pascal Meier (UK/Switzerland), Philip Moons (Belgium), Antonis Pantazis (UK), Massimo Francesco Piepoli (Italy), Bianca Rocca (Italy), Marco Roffi (Switzerland), Stephan Rosenkranz (Germany), Andrea Sarkozy (Belgium), Evgeny Shlyakhto (Russia), Candice K. Silversides (Canada), Karen Sliwa (South Africa), Miguel Sousa-Uva (Portugal), Juan Tamargo (Spain), Sara Thorne (UK), Marc Van de Velde1 (Belgium), Bryan Williams (UK), Jose Luis Zamorano (Spain) The disclosure forms of all experts involved in the development of these Guidelines are available on the ESC website www.escardio.org/guidelines

The current background information and detailed discussion of the data can be found in ESC CardioMed - Section 53 Pregnancy and heart disease Online publish-ahead-of-print 25 August 2018

................................................................................................................................................................................................... Keywords Guidelines • Pregnancy • Cardiovascular disease • Risk assessment • Management • Congenital heart disease • Valvular heart disease • Hypertension • Heart failure • Arrhythmia • Pulmonary hypertension • Aortic pathology • Cardiomyopathy • Drug therapy • Pharmacology

Table of Contents

Table of Contents. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3166 List of tables . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3168 Abbreviations and acronyms. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3168 1. Preamble . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3169 2. Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3171 2.1 Why do we need new Guidelines on the management of cardiovascular diseases in pregnancy? . . . . . . . . . . . . . . . . . . . . . . . . . . . 3171 2.2 New format of the Guidelines . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3171 2.3 Why these Guidelines are important. . . . . . . . . . . . . . . . . . . . . . . . 3171 2.4 Methods. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3171 2.5 What is new? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3172 3. General considerations. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3173 3.1 Epidemiology . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3173 3.2 Physiological adaptations to pregnancy . . . . . . . . . . . . . . . . . . . . . . 3174 3.3 Pre-pregnancy counselling . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3174 3.3.1 Risk of maternal cardiovascular complications. . . . . . . . . 3174 3.3.2 Risk of obstetric and offspring complications . . . . . . . . . . 3174 3.3.3 Pregnancy heart team. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3176 3.4 Cardiovascular diagnosis in pregnancy. . . . . . . . . . . . . . . . . . . . . . . 3176 3.4.1 Electrocardiography . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3176 3.4.2 Echocardiography . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3176 3.4.3 Exercise testing. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3177 3.4.4 Ionizing radiation exposure . . . . . . . . . . . . . . . . . . . . . . . . . . 3177 3.4.5 Chest radiography and computed tomography . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3177 3.4.6 Cardiac catheterization . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3177 3.4.7 Magnetic resonance imaging. . . . . . . . . . . . . . . . . . . . . . . . . . 3177 3.5 Genetic testing and counselling . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3177 3.5.1 Pre-natal diagnosis. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3178 3.6 Foetal assessment . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3178 3.6.1 Screening for congenital heart disease . . . . . . . . . . . . . . . . 3178 3.6.2 Assessing foetal wellbeing. . . . . . . . . . . . . . . . . . . . . . . . . . . . 3178 3.7 Interventions in the mother during pregnancy . . . . . . . . . . . . . . . 3178 3.7.1 Percutaneous therapy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3178 3.7.2 Cardiac surgery with cardiopulmonary bypass . . . . . . . . 3178 3.8 Timing and mode of delivery: risk for mother and child. . . . . . . 3179 3.8.1 Timing of delivery . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3179 3.8.2 Labour induction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3179 3.8.3 Vaginal or caesarean delivery. . . . . . . . . . . . . . . . . . . . . . . . . 3179 3.8.4 Delivery in anticoagulated women (not including mechanical valve; see section 5) . . . . . . . . . . . . . . . . . . . . . . . . . . . 3179 3.8.5 Urgent delivery on therapeutic anticoagulation. . . . . . . . 3179 3.8.6 Haemodynamic monitoring during delivery . . . . . . . . . . . 3180 3.8.7 Anaesthesia/analgesia . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3180 3.8.8 Labour. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3180 3.8.9 Perimortem caesarean section . . . . . . . . . . . . . . . . . . . . . . . 3180 Downloaded from academic.oup.com/eurheartj/article/39/34/3165/5078465 by guest on 07 October 2026