Grossesse sur Cœur Opéré: à Propos de 29 Cas

RESUMEIntroduction. La grossesse sur cardiopathie operee demeure une association a haut risque. Le but de cette etude etait d’evaluer l’issue maternelle et fœtale de la grossesse chez les femmes operees du cœur avec ou sans traitement anticoagulant. Patients et methodes. Nous avons realise une etude transversale retrospective et descriptive dans les services de cardiologie du CHU Gabriel Toure et du CHU Mere-Enfant de Bamako de 2017 au 2018. Nous avons inclus dans l’etude toutes les femmes suivies pour grossesse et ayant beneficie d’une chirurgie cardiaque ou d’un catheterisme interventionnel. Resultats. Sur un total de 29 parturientes, l’âge moyen etait de 26.41±7,3. Le rhumatisme articulaire aigu (62.07%) etait l’antecedent medical le plus frequent. Les valvulopathies rhumatismales ont constitue 82.76% de lesions cardiaques operees contre 17.24% pour les cardiopathies congenitales. L’annuloplastie mitrale (48.28%) etait la chirurgie la plus frequente suivi des protheses mecaniques (31.03%). L’evolution de la grossesse a ete normale chez toutes les parturientes. L’accouchement etait normal chez 69% des patientes. Les complications en post partum ont ete surtout : l’insuffisance cardiaque (55.16 %) et les troubles du rythme (24.14%). Le traitement anticoagulant (la warfarine) a ete prescrit chez 79.31% des femmes. Ni avortement spontane, ni mort fœtale, ni hemorragie de la delivrance n’ont ete signales sous anticoagulant. L’echographie cardiaque en post partum a trouve une fonction systolique du ventricule gauche alteree chez 51.72%. Conclusion. Les mesures de surveillances et de suivis appropries sont necessaires afin d’eviter des complications fœto-maternelles de la grossesse sur cœur opere.ABSTRACTIntroduction. Pregnancy associated with operated heart is a high risk association. The aim of our study was to report the maternal and fetal outcome of pregnancy in women who have had heart surgery with or without anticoagulant therapy. Patients and methods. A retrospective and descriptive study was carried out in the cardiology departments of CHU Gabriel Toure and CHU Mere-Enfant de Bamako from 2017 to 2018. All the women followed for pregnancy and having benefited from a surgical treatment or interventional catheterization were included in the study. Results. In our study group of 29 women, the mean age was 26.41 ± 7.3. Rheumatic heart disease (62.07%) was the most common past medical history. Rheumatic valve disease constituted 82.76% of operated cardiac lesions against 17.24% for congenital heart disease. Mitral annuloplasty (48.28%) was the most common surgical repair modality followed by mechanical prostheses (31.03%). The course of the pregnancy was normal for all of the women. Delivery was normal in 69% of the pregnancies. The postpartum complications were mainly: heart failure (55.16%) and arrhythmias (24.14%). Anticoagulant therapy (warfarin) was prescribed in 79.31%. Neither spontaneous abortion, fetal death, nor delivery haemorrhage were encounteredwith anticoagulant therapy. Postpartum cardiac ultrasound found impaired systolic left ventricular function in 51.72% of patients. Conclusion. Appropriate monitoring and follow-up measures are necessary in order to avoid fetal-maternal complications of pregnancy on an operated heart.