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Heart Disease in Pregnancy - part 7

Dị tật bẩm sinh mạch vành là thỉnh thoảng gặp phải trong thời kỳ mang thai và bệnh nhân với tetralogies sửa chữa và các khuyết tật khác đã sống đủ lâu để được nhìn thấy với bệnh mua lại vành atheromatous. | 212 Chapter 15 should be encouraged and measures set in place to maintain a lifelong healthy lifestyle. Congenital coronary anomalies Congenital coronary anomalies are occasionally encountered in pregnancy and patients with repaired tetralogies and other defects have now lived long enough to be seen with acquired atheromatous coronary disease. Occasional patients with previously unrecognized corrected transposition are referred with angina and mitral regurgitation thought to be ischemic in origin. They often have poor function of the systemic right ventricle and atrial fibrillation or atrioventricular conduction defects. A continuous murmur caused by a coronary cameral fistula may first be detected during antenatal examination. It is usually distinguishable from a patent duct by an unusual location. Echocardiography will usually display the anomaly but small ones may be hard to spot Figure 15.2 . Even large fistulae may be symptom free and cause no trouble in pregnancy but should be closed after the pregnancy. Small fistulae should be left alone. Connections can be multiple and are best tackled percutaneously. Anomalous origin of a coronary artery usually the left from the pulmonary artery with poor left ventricular function as a result of neonatal infarction or progressive ischaemia caused by increasing fistulous flow from right to left coronary artery may present with angina 45 mitral regurgitation or left ventricular failure. The patient illustrated in Figure 15.3 had undergone two uneventful pregnancies before she was referred with angina mitral regurgitation and failure. She did well after ligation of the left coronary artery at its ostium and Figure 15.2 One frame from a left coronary angiogram of a young girl who was found to have a murmur at a routine examination. This was continuous and placed maximally at the third left interspace too low for a patent ductus. Echocardiography showed flow into the main pulmonary artery just distal to the valve. Coronary .