Hipertensión pulmonar y embarazo

• Gloria Valdés S ; Robert Matthei F ; María Soledad Fernández V ; Carmen Schacht F ; Jenny Corthorn H ; Alfredo M Germaín A ^[1]
  1. [1] Pontificia Universidad Católica Facultad de Medicina Departamento de Obstetricia y Ginecología
• Localización: Revista Médica de Chile, ISSN-e 0034-9887, Vol. 130, Nº. 2, 2002, págs. 201-208
• Idioma: español
• Títulos paralelos:
  • Pulmonary hypertension and pregnancy
• Enlaces
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• Resumen

  • A 36 year old woman, with an 18 year history of syncope, became pregnant shortly after a cardiac catheterization demonstrated a high pulmonary arterial pressure and resistance and a low cardiac output. During pregnancy she remained stable at NYHA FC III, on nifedipine, apresoline, isosorbide, aspirin and bed rest. At 28 weeks, catheterization showed a decreased pulmonary pressure and an increased cardiac output. At 38 weeks, she was submitted to an elective caesarean section, and delivered a healthy newborn of 2820 g. After 5 months, her catheterization showed a pulmonary artery pressure similar to the pre-pregnancy study. Her condition deteriorated, leading to death 10 months later. Urinary 6-keto-PGF1∂, nitrates/nitrites, kallikrein and angiotensin-(1-7) were increased from 13 to 33 weeks, to drop in week 35 of pregnancy. The safe maternal and fetal outcome, and the intragestational hemodynamic improvement are attributed to a close multidisciplinary surveillance, and to the effects of the endogenous vasodilators of pregnancy on the reversible component of the pulmonary hypertension. Reports in the literature show a decrease in maternal mortality rate, from 56% for the period previous to 1963, to 34 and 30% for those spanning between 1978-1996 y 1997-2001 respectively (Rev Méd Chile 2002; 130: 201-8)