Infective endocarditis and pregnancy
Abstract
Infective endocarditis in pregnant women is a threatening disease that leads to significant maternal and perinatal losses. Methods for caring for such patients have not yet been standardized, and literature sources provide single descriptions of case reports.
Objectives. To reduce maternal and perinatal mortality and disability, as well as to provide optimal management and delivery strategy for pregnant women with infective endocarditis.
Materials and methods.This paper presents the experience of treating three cases of IE in pregnant women (n-2) and parturient (n-1) by specialists of a national multidisciplinary team. In all three cases, cardiology, cardiac surgery and perinatal tactics were personalized in accordance with the recommendations of the European Society of Cardiologists and the experience of the team members. Parturient with acute IE and septic clot of right ventricle underwent urgent cardiac surgery. Another pregnant was provided with conservative support by a multidisciplinary team due to the absence of indications for immediate surgery (she underwent aortic valve replacement and mitral valve repair in 11 days after in-term labour). The third one underwent cardiac surgery (mitral valve repair) with fetus in utero at 21 weeks of pregnancy after 11 weeks of de-escalation therapy by antibiotics.
Results. In all cases, the immediate maternal and perinatal results were good. Follow-up for two cases we could observe (33 and 18 months after surgery) are good.
Conclusions. Treatment tactic for pregnant women with acute IE that require heart surgery is always a compromise between the treatment and rehabilitation of a deep-preterm baby and the intra-operative risks to the fetus. Risk of intervention for mother and fetus can be minimized by a highly professional multidisciplinary team with wide experience in open-heart surgery, competent preparation of women for surgical treatment, conducting intraoperative fetal monitoring, as well as using special parameters of artificial circulation and anesthesia. Primary and secondary prevention of infectious complications in pregnant women at risk of IE is a powerful tool to reduce maternal, perinatal mortality and disability.
References
- Regitz-Zagrosek V, Blomstrom Lundqvist C, Borghi C, Cifkova R, Ferreira R, Foidart JM, et al. ESC Guidelines on the management of cardiovascular diseases during pregnancy: the task force on the management of cardiovascular diseases during pregnancy of the European Society of Cardiology (ESC). Eur Heart J. 2011;32:3147–97. https://doi.org/10.1093/eurheartj/ehr218
- Abbas AE, Lester SJ, Connolly H. Pregnancy and the cardiovascular system. Int J Cardiol. 2005;98:179–89. https://doi.org/10.1016/j.ijcard.2003.10.028
- Montoya ME, Karnath BM, Ahmad M. Endocarditis during pregnancy. Southern Med J. 2003;96:1156–7. https://doi.org/10.1097/01.SMJ.0000054503.18393.1E
- Krcmery V, Gogova M, Ondrusova A, Buckova E, Doczeova A, Mrazova M, et al. Etiology and risk factors of 339 cases of infective endocarditis: report from a 10-year national prospective survey in the Slovak Republic. J Chemotherapy. 2003;15:579–83. https://doi.org/10.1179/joc.2003.15.6.579
- Li JS, Sexton DJ, Mick N, Nettles R, Fowler VG Jr, Ryan T, et al. Proposed modifications to the Duke criteria for the diagnosis of infective endocarditis. Clin Inf Dis. 2000;30:633–8. https://doi.org/10.1086/313753
- Frank KL, Del Pozo JL, Patel R. From clinical microbiology to infection pathogenesis: how daring to be different works for Staphylococcus lugdunensis. Clin Microbiol Rev. 2008;21:111–33. https://doi.org/10.1128/CMR.00036-07
- Campuzano K, RoquйH, Bolnick A, Leo MV, Campbell WA. Bacterial endocarditis complicating pregnancy: case report and systematic review of the literature. Arch Gynecol Obstet. 2003;268:251–5. https://doi.org/10.1007/s00404-003-0485-x
- Di Salvo G, Habib G, Pergola V, Avierinos JF, Philip E, Casalta JP, et al. Echocardiography predicts embolic events in infective endocarditis. J Am Coll Cardiol. 2001;37:1069–76. https://doi.org/10.1016/s0735-1097(00)01206-7
- Frontera JA, Gradon JD. Right-side endocarditis in injection drug users: review of proposed mechanisms of pathogenesis. Clin Infect Dis. 2000;30:374–9. https://doi.org/10.1086/313664
- Munoz-Suano A, Hamilton AB, Betz AG. Gimme shelter: the immune system during pregnancy. Immunol Rev. 2011;241:20–38. https://doi.org/10.1111/j.1600-065X.2011.01002.x
- Habib G, Lancellotti P, Antunes MJ, Bongiorni MG, Casalta JP, Del Zotti F, et al. 2015 ESC Guidelines for the management of infective endocarditis. European Heart Journal. 2015;36:3075–3128. https://doi.org/10.1093/eurheartj/ehv319
- Regitz-Zagrosek V, Roos-Hesselink JW, Bauersachs J, Blomstrцm-Lundqvist C, CнfkovбR, De Bonis M, et al. 2018 ESC Guidelines for the management of cardiovascular diseases during pregnancy. European Heart Journal. 2018;39: 3165–241. https://doi.org/10.1093/eurheartj/ehy340
- Kastelein AW, Oldenburger NY, van Pampus MG, Janszen EW. Severe endocarditis and open-heart surgery during pregnancy. BMJ Case Rep. 2016 Nov 25;2016. pii: bcr2016217510. https://doi.org/10.1136/bcr-2016-217510
- PicichиM, Charbonneau E, Baillot R. Management of Acute Aortic Infective Endocarditis in Pregnancy. Journal of Cardiology and Therapeutics. 2013;1:17–9. https://doi.org/10.12970/2311-052X.2013.01.01.4
- Tripp HF, Stiegel RM, Coyle J. The use of pulsatile perfusion during aortic valve replacement in pregnancy. Ann Thorac Surg. 1999;67:1169–71. https://doi.org/10.1016/s0003-4975(99)00113-7
- Teharani H, Masroor S, Lombardi P, Rosenkraz E, Salerno T. Beating heart aortic valve replacement in a pregnant patient. J Card Surg. 2004;19:57–8. https://doi.org/10.1111/j.0886-0440.2004.02067.x
- Siromakha SO, Davydova YuV, Lymanska AYu, Lazoryshynets VV. [Multidisciplinary Support for Pregnant and Parturient with Congenital Heart Disease]. Cardiovascular Surgery Herald. 2019;1:31–7. Ukrainian. https://doi.org/10.30702/ujcvs/19.35/07(031-037)
