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2018 ESC Guidelines for the Management of Cardiovascular

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2018 ESC Guidelines for the Management of Cardiovascular European Heart Journal (2018) 00,1–83 ESC GUIDELINES doi:10.1093/eurheartj/ehy340 2018 ESC Guidelines for the management of cardiovascular diseases during pregnancy The Task Force for the Management of Cardiovascular Diseases during Pregnancy of the European Society of Cardiology (ESC) Endorsed by: the International Society of Gender Medicine (IGM), the German Institute of Gender in Medicine (DGesGM), the European Society of Anaesthesiology (ESA), and the European Society of Gynecology (ESG) Authors/Task Force Members: Vera Regitz-Zagrosek* (Chairperson) (Germany), Jolien W. Roos-Hesselink* (Co-Chairperson) (The Netherlands), Johann Bauersachs (Germany), Carina Blomstro¨m-Lundqvist (Sweden), Renata Cıfkova (Czech Republic), Michele De Bonis (Italy), Bernard Iung (France), Mark Richard Johnson (UK), Ulrich Kintscher (Germany), Peter Kranke1 (Germany), Irene Marthe Lang (Austria), Joao Morais (Portugal), Petronella G. Pieper (The Netherlands), Patrizia Presbitero (Italy), Susanna Price (UK), Giuseppe M. C. Rosano (UK/Italy), Ute Seeland (Germany), Tommaso Simoncini2 (Italy), Lorna Swan (UK), Carole A. Warnes (USA) * Corresponding authors. Vera Regitz-Zagrosek, Charite´ Universitaetsmedizin Berlin, Institute for Gender in Medicine, CCR, DZHK, partner site Berlin, Hessische Str 3-4, 10115 Berlin, Germany, Tel: þ49 30 450 525 288, Fax: þ49 30 450 7 525 288, E-mail: [email protected]. Jolien W. Roos-Hesselink, Department of Cardiology, Erasmus Medical Center Rotterdam, Dr Molewaterplein 40, 3015CGD, Rotterdam, Netherlands, Tel: þ31 10 7032432, E-mail: [email protected] ESC Committee for Practice Guidelines (CPG) and National Cardiac Societies document reviewers: listed in the Appendix. 1Representing the European Society of Anaesthesiology (ESA) 2Representing the European Society of Gynecology (ESG) ESC entities having participated in the development of this document: Associations: Acute Cardiovascular Care Association (ACCA), European Association of Cardiovascular Imaging (EACVI), European Association of Percutaneous Cardiovascular Interventions (EAPCI), European Heart Rhythm Association (EHRA), Heart Failure Association (HFA). Councils: Council on Cardiovascular Nursing and Allied Professions, Council on Cardiovascular Primary Care, Council on Hypertension, Council on Valvular Heart Disease. Working Groups: Aorta and Peripheral Vascular Diseases, Cardiovascular Pharmacotherapy, Cardiovascular Surgery, Grown-up Congenital Heart Disease, Myocardial and Pericardial Diseases, Pulmonary Circulation and Right Ventricular Function, Thrombosis. The content of these European Society of Cardiology (ESC) Guidelines has been published for personal and educational use only. No commercial use is authorized. No part of the ESC Guidelines may be translated or reproduced in any form without written permission from the ESC. Permission can be obtained upon submission of a written request to Oxford University Press, the publisher of the European Heart Journal and the party authorized to handle such permissions on behalf of the ESC ([email protected]). Disclaimer. The ESC Guidelines represent the views of the ESC and were produced after careful consideration of the scientific and medical knowledge and the evidence avail- able at the time of their dating. The ESC is not responsible in the event of any contradiction, discrepancy and/or ambiguity between the ESC Guidelines and any other official rec- ommendations or guidelines issued by the relevant public health authorities, in particular in relation to good use of health care or therapeutic strategies. Health professionals are encouraged to take the ESC Guidelines fully into account when exercising their clinical judgment as well as in the determination and the implementation of preventive, diagnostic or therapeutic medical strategies. However, the ESC Guidelines do not override in any way whatsoever the individual responsibility of health professionals to make appropriate and accurate decisions in consideration of each patient’s health condition and in consultation with that patient and the patient’s caregiver where appropriate and/or necessary. Nor do the ESC Guidelines exempt health professionals from taking careful and full consideration of the relevant official updated recommendations or guidelines issued by the competent public health authorities in order to manage each patient’s case in light of the scientifically accepted data pursuant to their respective ethical and professional obliga- tions. It is also the health professional’s responsibility to verify the applicable rules and regulations relating to drugs and medical devices at the time of prescription. VC The European Society of Cardiology and The European Society of Hypertension 2018. All rights reserved. For permissions please email: [email protected]. Downloaded from https://academic.oup.com/eurheartj/advance-article-abstract/doi/10.1093/eurheartj/ehy340/5078465 by guest on 25 August 2018 2 ESC Guidelines 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 ................................................................................................................................................................................................... Keywords Guidelines • Pregnancy • Cardiovascular disease • Risk assessment • Management • Congenital heart dis- ease • Valvular heart disease • Hypertension • Heart failure • Arrhythmia • Pulmonary hypertension • Aortic pathology • Cardiomyopathy • Drug therapy • Pharmacology . 3.4.4Ionizingradiationexposure.............................12 Table of Contents . 3.4.5 Chest radiography and computed TableofContents....................................................2 . tomography.................................................12 . Listoftables.........................................................4 . 3.4.6Cardiaccatheterization.................................12 . Abbreviationsandacronyms..........................................4 . 3.4.7Magneticresonanceimaging.............................12 1.Preamble..........................................................5 . 3.5Genetictestingandcounselling................................12 . 2.Introduction.......................................................6 . 3.5.1Pre-nataldiagnosis......................................13 2.1 Why do we need new Guidelines on the management of . 3.6Foetalassessment.............................................13 . cardiovasculardiseasesinpregnancy?...............................6 . 3.6.1 Screening for congenital heart disease . 13 2.2NewformatoftheGuidelines..................................6 . 3.6.2Assessingfoetalwellbeing...............................13 . 2.3WhytheseGuidelinesareimportant............................6 . 3.7Interventionsinthemotherduringpregnancy..................13 2.4Methods.......................................................6 . 3.7.1Percutaneoustherapy..................................13 . 2.5Whatisnew?..................................................7 . 3.7.2 Cardiac surgery with cardiopulmonary bypass . 13 3.Generalconsiderations.............................................8 . 3.8 Timing and mode of delivery: risk for mother and child . 14 . 3.1Epidemiology..................................................8 . 3.8.1Timingofdelivery......................................14 3.2Physiologicaladaptationstopregnancy..........................9 . 3.8.2Labourinduction.......................................14 . 3.3Pre-pregnancycounselling......................................9 . 3.8.3Vaginalorcaesareandelivery............................14 3.3.1 Risk of maternal cardiovascular complications. 9 . 3.8.4 Delivery in anticoagulated women (not including . 3.3.2 Risk of obstetric and offspring complications . 9 . mechanicalvalve;seesection5)..............................14 3.3.3Pregnancyheartteam...................................11 . 3.8.5 Urgent delivery on therapeutic anticoagulation. 14 . 3.4Cardiovasculardiagnosisinpregnancy..........................11 . 3.8.6 Haemodynamic monitoring during delivery . 15 3.4.1Electrocardiography....................................11 . 3.8.7Anaesthesia/analgesia...................................15 . 3.4.2Echocardiography......................................11 . 3.8.8Labour.................................................15 3.4.3Exercisetesting.........................................12 . 3.8.9Perimortemcaesareansection..........................15
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