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Countouris ME, Marino AL, Raymond M, Hauspurg A, Berlacher KL. Infective Endocarditis in Pregnancy: A Contemporary Cohort. Am J Perinatol 2024; 41:e230-e235. [PMID: 35709725 PMCID: PMC9943787 DOI: 10.1055/a-1877-5763] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
OBJECTIVE Pregnancy-related infective endocarditis (IE) caries a high risk of morbidity and mortality. With increasing intravenous drug abuse (IVDA) amid the opioid epidemic, the risk factor profile may be shifting. In this case series, we aimed to describe risk factors and outcomes for peripartum IE in a contemporary cohort. STUDY DESIGN We identified patients with IE diagnosed during pregnancy or up to 6 weeks' postpartum from 2015 through 2018 at a single tertiary care center. We abstracted detailed medical history and clinical outcome measures from the electronic medical record. The diagnosis of IE was supported by the modified Duke Criteria. RESULTS Nine patients had peripartum IE: eight (89%) with a history of IVDA, one with an indwelling central venous catheter (11%), and one with prior IE (11%). None had preexisting congenital or valvular heart disease. Six (67%) had comorbid hepatitis C. Eight cases (89%) had gram-positive cocci with vegetations involving the tricuspid valve (56%) and both mitral and tricuspid valves (22%). Major complications included shock (33%), mechanical ventilation (44%), septic emboli (67%), and noncardiac abscesses (33%). Two patients underwent valve surgery, and there were two cases of postpartum maternal mortality (22%), one from septic shock and one from intracerebral hemorrhage. While four patients (44%) delivered preterm (average gestational age 35 weeks), most delivered vaginally (89%) with only one requiring an emergent caesarean section. There was no fetal mortality, although three newborns (43%) required admission to the neonatal intensive care unit. Two patients were initiated on medication-assisted treatment for opioid use disorder. Consultants included infectious disease, cardiology, cardiac surgery, maternal-fetal medicine, and psychiatry. CONCLUSION These findings confirm that IVDA is a growing risk factor for pregnancy-related IE. Peripartum IE carries a high risk of complications, including maternal mortality, and warrants management with a multidisciplinary care team at a tertiary center. KEY POINTS · Intravenous drug use was the most common risk factor for IE in pregnancy.. · IE in pregnancy carries a high morbidity and mortality with complications including septic emboli, septic shock, and need for mechanical ventilation.. · A multidisciplinary team approach can assure the best possible maternal and fetal outcomes..
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Affiliation(s)
- Malamo E Countouris
- University of Pittsburgh Medical Center, Heart and Vascular Institute, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Amy L Marino
- University of Pittsburgh Medical Center, Heart and Vascular Institute, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Megan Raymond
- Department of Obstetrics and Gynecology, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania
| | - Alisse Hauspurg
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, University of Pittsburgh Medical Center University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Kathryn L Berlacher
- University of Pittsburgh Medical Center, Heart and Vascular Institute, University of Pittsburgh, Pittsburgh, Pennsylvania
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2
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Yagel O, Alter R, Nissan B, Zwas DR, Rosenbloom JI, Eyal O, Golomb M, Planer D, Elbaz-Greener G. A Pregnant Woman With Severe Symptomatic Aortic Stenosis: How Should We Treat? JACC Case Rep 2024; 29:102205. [PMID: 38361553 PMCID: PMC10865217 DOI: 10.1016/j.jaccas.2023.102205] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2023] [Revised: 12/04/2023] [Accepted: 12/12/2023] [Indexed: 02/17/2024]
Abstract
A 31-year-old woman with end-stage kidney disease and with a bicuspid aortic valve presented with acute heart failure in the second trimester of pregnancy. The patient received a diagnosis of severe aortic stenosis and chose to continue the pregnancy against medical advice. Following a multidisciplinary team consultation, she underwent urgent transcatheter aortic valve replacement.
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Affiliation(s)
- Oren Yagel
- Department of Cardiology, Hadassah Medical Center, The Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Roie Alter
- Department of Obstetrics and Gynecology, Hadassah Medical Center, The Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Batel Nissan
- Department of Cardiology, Hadassah Medical Center, The Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Donna R. Zwas
- Department of Cardiology, Hadassah Medical Center, The Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Joshua I. Rosenbloom
- Department of Obstetrics and Gynecology, Hadassah Medical Center, The Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Ophir Eyal
- Department of Nephrology and Hypertension, Hadassah Medical Center, The Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Mordechai Golomb
- Department of Cardiology, Hadassah Medical Center, The Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - David Planer
- Department of Cardiology, Hadassah Medical Center, The Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Gabby Elbaz-Greener
- Department of Cardiology, Hadassah Medical Center, The Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
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3
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Pande SN, Munuswamy H, Rath DP, Prasad SKS, Baghel J, Pillai AA, Parida S, Mondal N, Keepanasseril A. Concurrent valve replacement and caesarean section for rheumatic mitral valve disease with refractory heart failure in late pregnancy. Obstet Med 2023; 16:156-161. [PMID: 37719999 PMCID: PMC10504886 DOI: 10.1177/1753495x221118433] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2022] [Accepted: 07/19/2022] [Indexed: 09/19/2023] Open
Abstract
Objective To assess clinical characteristics and outcomes of women who underwent concurrent valve replacement with caesarean section for severe rheumatic mitral valve disease with refractory heart failure. Methods All women admitted to a single centre from 2011 to 2020 with severe rheumatic mitral valve disease, having recurrent episodes of pulmonary edema on optimal medical therapy and contraindication to percutaneous balloon mitral valvotomy, who underwent concurrent valve replacement (for native valve disease) along with caesarean section, were included. Results Among 1300 pregnancies with rheumatic heart disease, six underwent the concurrent procedure. All had replacement of mitral valve except one who had both aortic and mitral valve replacements, between 33 and 39 weeks of gestation. There were no maternal deaths, and there was one neonatal loss from late-onset sepsis. Conclusion Pregnant women with severe rheumatic mitral valve disease with refractory heart failure, unsuitable for minimal access interventions, can be considered for a concurrent valve replacement with caesarean section.
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Affiliation(s)
- Swaraj N Pande
- Department of Obstetrics and Gynaecology, Jawaharlal Institute of Post-graduate Medical Education & Research (JIPMER), Puducherry, India
| | - Hemachandren Munuswamy
- Department of Cariothoracic Vascular Surgery, Jawaharlal Institute of Post-graduate Medical Education & Research (JIPMER), Puducherry, India
| | - Durga P Rath
- Department of Cariothoracic Vascular Surgery, Jawaharlal Institute of Post-graduate Medical Education & Research (JIPMER), Puducherry, India
| | - Sreevathsa KS Prasad
- Department of Cariothoracic Vascular Surgery, Jawaharlal Institute of Post-graduate Medical Education & Research (JIPMER), Puducherry, India
| | - Jyoti Baghel
- Department of Obstetrics and Gynaecology, Jawaharlal Institute of Post-graduate Medical Education & Research (JIPMER), Puducherry, India
| | - Ajith A Pillai
- Department of Cardiology, Jawaharlal Institute of Post-graduate Medical Education & Research (JIPMER), Puducherry, India
| | - Satyen Parida
- Department of Anaesthesiology and Critical Care, Jawaharlal Institute of Post-graduate Medical Education & Research (JIPMER), Puducherry, India
| | - Nivedita Mondal
- Department of Neonatology, Jawaharlal Institute of Post-graduate Medical Education & Research (JIPMER), Puducherry, India
| | - Anish Keepanasseril
- Department of Obstetrics and Gynaecology, Jawaharlal Institute of Post-graduate Medical Education & Research (JIPMER), Puducherry, India
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4
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Brandstetter M, Neuner M, Dinges C, Hofstätter E, Wohlmuth C, Fazelnia C, Fischer T, Bogner G. Fetal Doppler monitoring during maternal open-heart surgery: Case report and key aspects of a multidisciplinary challenge. Eur J Obstet Gynecol Reprod Biol 2023; 287:63-66. [PMID: 37295346 DOI: 10.1016/j.ejogrb.2023.05.034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Accepted: 05/25/2023] [Indexed: 06/12/2023]
Abstract
CASE REPORT Herein we present the case of a 33-year nulliparous woman at 21 weeks of gestation with mitral valve vegetation resulting from infective endocarditis. Due to the mother's critical condition caused by consecutive thromboembolic events, surgery with cardiopulmonary bypass was indicated. During surgery the fetus was monitored by a specialized obstetrician who repetitively measured the Doppler indices of the umbilical artery, Ductus venosus and uterine artery. Right after CO2 was insufflated into the operating area, the Doppler monitoring showed an increased Pulsatility Index of the Umbilical artery right before fetal distress with bradycardia occurred. A subsequent maternal arterial blood gas analysis showed an acidosis with hypercapnia. Consequently, the CO2 insufflation was stopped and the gas flow on the Heart Lung Machine increased. After regaining homeostasis of acidosis, the Doppler Indices and fetal heart rate recovered. The remaining surgery and postoperative course were uneventful. At the 37 weeks of gestation a healthy boy was delivered by Cesarean section and at the age of two years, the neurodevelopment was assessed, which indicated normal development in mental cognition, language and motoric. This report presents a periodic Doppler examination of the maternal and fetal circulation during surgery on CPB while also discussing the possible impact of fetal monitoring in managing open cardiac surgery in pregnancy.
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Affiliation(s)
| | - Matthias Neuner
- Department of Anesthesiology, Paracelsus Medical University, Salzburg, Austria
| | - Christian Dinges
- Department of Heart Surgery, Paracelsus Medical University, Salzburg, Austria
| | - Edda Hofstätter
- Department of Neonatology, Paracelsus Medical University, Salzburg, Austria
| | - Christoph Wohlmuth
- Department of Obstetrics and Gynecology, Paracelsus Medical University, Salzburg, Austria
| | - Claudius Fazelnia
- Department of Obstetrics and Gynecology, Paracelsus Medical University, Salzburg, Austria
| | - Thorsten Fischer
- Department of Obstetrics and Gynecology, Paracelsus Medical University, Salzburg, Austria
| | - Gerhard Bogner
- Department of Obstetrics and Gynecology, Paracelsus Medical University, Salzburg, Austria.
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Onofrei VA, Adam CA, Marcu DTM, Crisan Dabija R, Ceasovschih A, Constantin M, Grigorescu ED, Petroaie AD, Mitu F. Infective Endocarditis during Pregnancy-Keep It Safe and Simple! MEDICINA (KAUNAS, LITHUANIA) 2023; 59:medicina59050939. [PMID: 37241171 DOI: 10.3390/medicina59050939] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/12/2023] [Revised: 05/09/2023] [Accepted: 05/10/2023] [Indexed: 05/28/2023]
Abstract
The diagnosis of infective endocarditis (IE) during pregnancy is accompanied by a poor prognosis for both mother and fetus in the absence of prompt management by multidisciplinary teams. We searched the electronic databases of PubMed, MEDLINE and EMBASE for clinical studies addressing the management of infective endocarditis during pregnancy, with the aim of realizing a literature review ranging from risk factors to diagnostic investigations to optimal therapeutic management for mother and fetus alike. The presence of previous cardiovascular pathologies such as rheumatic heart disease, congenital heart disease, prosthetic valves, hemodialysis, intravenous catheters or immunosuppression are the main risk factors predisposing patients to IE during pregnancy. The identification of modern risk factors such as intracardiac devices and intravenous drug administration as well as genetic diagnostic methods such as cell-free deoxyribonucleic acid (DNA) next-generation sequencing require that these cases be addressed in multidisciplinary teams. Guiding treatment to eradicate infection and protect the fetus simultaneously creates challenges for cardiologists and gynecologists alike.
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Affiliation(s)
- Viviana Aursulesei Onofrei
- Department of Medical Specialties I, II, III and Preventive Medicine and Interdisciplinary, "Grigore T. Popa" University of Medicine and Pharmacy, University Street No. 16, 700115 Iasi, Romania
- "St. Spiridon" Clinical Emergency Hospital, Independence Boulevard No. 1, 700111 Iasi, Romania
| | - Cristina Andreea Adam
- Department of Medical Specialties I, II, III and Preventive Medicine and Interdisciplinary, "Grigore T. Popa" University of Medicine and Pharmacy, University Street No. 16, 700115 Iasi, Romania
- Cardiovascular Rehabilitation Clinic, Clinical Rehabilitation Hospital, Pantelimon Halipa Street No. 14, 700661 Iasi, Romania
| | - Dragos Traian Marius Marcu
- Department of Medical Specialties I, II, III and Preventive Medicine and Interdisciplinary, "Grigore T. Popa" University of Medicine and Pharmacy, University Street No. 16, 700115 Iasi, Romania
- Clinical Hospital of Pneumophthisiology Iași, Doctor Iosif Cihac Street No. 30, 700115 Iasi, Romania
| | - Radu Crisan Dabija
- Department of Medical Specialties I, II, III and Preventive Medicine and Interdisciplinary, "Grigore T. Popa" University of Medicine and Pharmacy, University Street No. 16, 700115 Iasi, Romania
- Clinical Hospital of Pneumophthisiology Iași, Doctor Iosif Cihac Street No. 30, 700115 Iasi, Romania
| | - Alexandr Ceasovschih
- Department of Medical Specialties I, II, III and Preventive Medicine and Interdisciplinary, "Grigore T. Popa" University of Medicine and Pharmacy, University Street No. 16, 700115 Iasi, Romania
- "St. Spiridon" Clinical Emergency Hospital, Independence Boulevard No. 1, 700111 Iasi, Romania
| | - Mihai Constantin
- Department of Medical Specialties I, II, III and Preventive Medicine and Interdisciplinary, "Grigore T. Popa" University of Medicine and Pharmacy, University Street No. 16, 700115 Iasi, Romania
- "St. Spiridon" Clinical Emergency Hospital, Independence Boulevard No. 1, 700111 Iasi, Romania
| | - Elena-Daniela Grigorescu
- Department of Medical Specialties I, II, III and Preventive Medicine and Interdisciplinary, "Grigore T. Popa" University of Medicine and Pharmacy, University Street No. 16, 700115 Iasi, Romania
| | - Antoneta Dacia Petroaie
- Department of Medical Specialties I, II, III and Preventive Medicine and Interdisciplinary, "Grigore T. Popa" University of Medicine and Pharmacy, University Street No. 16, 700115 Iasi, Romania
| | - Florin Mitu
- Department of Medical Specialties I, II, III and Preventive Medicine and Interdisciplinary, "Grigore T. Popa" University of Medicine and Pharmacy, University Street No. 16, 700115 Iasi, Romania
- Cardiovascular Rehabilitation Clinic, Clinical Rehabilitation Hospital, Pantelimon Halipa Street No. 14, 700661 Iasi, Romania
- Academy of Medical Sciences, Ion C. Brătianu Boulevard No. 1, 030167 Bucharest, Romania
- Academy of Romanian Scientists, Professor Dr. Doc. Dimitrie Mangeron Boulevard No. 433, 700050 Iasi, Romania
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Hao J, Liu S, Sun T, Lei L. Case report: Acute right ventricular dysfunction after surgery in a pregnant patient with congenital heart disease and aortic dissection. Front Cardiovasc Med 2023; 10:1146158. [PMID: 37034325 PMCID: PMC10076818 DOI: 10.3389/fcvm.2023.1146158] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Accepted: 03/01/2023] [Indexed: 04/11/2023] Open
Abstract
Pregnant women with aortic dissection are hemodynamically outmost complex patients. The two major diagnoses that should be considered in pregnant patients with congenital heart disease (CHD) and acute type A aortic dissection presenting with postoperative right ventricular dysfunction are pulmonary thromboembolism and right ventricular infarction. We present a rare case of postoperative right ventricular dysfunction in pregnant women with CHD and acute aortic dissection, which was diagnosed by pulmonary computed tomography angiography and treated by percutaneous coronary intervention.
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Affiliation(s)
- Junhai Hao
- Department of Intensive Care Unit of Cardiac Surgery, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, China
- Laboratory of South China Structural Heart Disease, Guangzhou, China
| | - Siyi Liu
- Department of Intensive Care Unit of Cardiac Surgery, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, China
- Laboratory of South China Structural Heart Disease, Guangzhou, China
| | - Tucheng Sun
- Department of Cardiac Surgery, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, China
- Correspondence: Tucheng Sun Liming Lei
| | - Liming Lei
- Department of Intensive Care Unit of Cardiac Surgery, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, China
- Laboratory of South China Structural Heart Disease, Guangzhou, China
- Correspondence: Tucheng Sun Liming Lei
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7
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Stephens EH, Dearani JA, Overman DM, Deyle DR, Rose CH, Ashikhmina E, Jain CC, Miranda WR, Connolly HM. Pregnancy heart team: A lesion-specific approach. J Thorac Cardiovasc Surg 2022:S0022-5223(22)01356-3. [PMID: 36658028 DOI: 10.1016/j.jtcvs.2022.12.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2022] [Revised: 12/14/2022] [Accepted: 12/15/2022] [Indexed: 12/24/2022]
Affiliation(s)
- Elizabeth H Stephens
- Department of Cardiovascular Surgery, Mayo Clinic-Children's Minnesota Cardiovascular Collaborative, Rochester, Minn.
| | - Joseph A Dearani
- Department of Cardiovascular Surgery, Mayo Clinic-Children's Minnesota Cardiovascular Collaborative, Rochester, Minn
| | - David M Overman
- Children's Heart Clinic, Children's Minnesota, Mayo Clinic-Children's Minnesota Cardiovascular Collaborative, Minneapolis, Minn
| | - David R Deyle
- Department of Clinical Genomics, Mayo Clinic, Rochester, Minn; Department of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, Minn
| | - Carl H Rose
- Obstetrics and Gynecology, Mayo Clinic, Rochester, Minn
| | - Elena Ashikhmina
- Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, Minn
| | - C Charles Jain
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minn
| | | | - Heidi M Connolly
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minn
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8
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Zaleski KL, Blazey MH, Carabuena JM, Economy KE, Valente AM, Nasr VG. Perioperative Anesthetic Management of the Pregnant Patient With Congenital Heart Disease Undergoing Cardiac Intervention: A Systematic Review. J Cardiothorac Vasc Anesth 2022; 36:4483-4495. [PMID: 36195521 DOI: 10.1053/j.jvca.2022.09.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Revised: 08/29/2022] [Accepted: 09/01/2022] [Indexed: 11/11/2022]
Abstract
Maternal congenital heart disease is increasingly prevalent, and has been associated with a significantly increased risk of maternal, obstetric, and neonatal complications. For patients with CHD who require cardiac interventions during pregnancy, there is little evidence-based guidance with regard to optimal perioperative management. The periprocedural management of pregnant patients with congenital heart disease requires extensive planning and a multidisciplinary teams-based approach. Anesthesia providers must not only be facile in the management of adult congenital heart disease, but cognizant of the normal, but significant, physiologic changes of pregnancy.
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Affiliation(s)
- Katherine L Zaleski
- Department of Anesthesiology, Critical Care, and Pain Medicine-Boston Children's Hospital, Harvard Medical School, Boston, MA
| | | | - Jean M Carabuena
- Department of Anesthesiology, Perioperative and Pain Medicine-Brigham and Women's Hospital, Harvard Medical School, Boston MA
| | - Katherine E Economy
- Division of Maternal-Fetal Medicine, Brigham, and Women's Hospital, Harvard Medical School, Boston, MA
| | - Anne M Valente
- Department of Cardiology, Boston Children's Hospital, Harvard Medical School, Boston, MA
| | - Viviane G Nasr
- Department of Anesthesiology, Critical Care, and Pain Medicine-Boston Children's Hospital, Harvard Medical School, Boston, MA.
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9
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O’Kelly AC, Ludmir J, Wood MJ. Acute Coronary Syndrome in Pregnancy and the Post-Partum Period. J Cardiovasc Dev Dis 2022; 9:jcdd9070198. [PMID: 35877560 PMCID: PMC9319853 DOI: 10.3390/jcdd9070198] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Revised: 06/14/2022] [Accepted: 06/16/2022] [Indexed: 11/16/2022] Open
Abstract
Cardiovascular disease is the leading cause of maternal mortality in the United States. Acute coronary syndrome (ACS) is more common in pregnant women than in non-pregnant controls and contributes to the burden of maternal mortality. This review highlights numerous etiologies of chest discomfort during pregnancy, as well as risk factors and causes of ACS during pregnancy. It focuses on the evaluation and management of ACS during pregnancy and the post-partum period, including considerations when deciding between invasive and non-invasive ischemic evaluations. It also focuses specifically on the management of post-myocardial infarction complications, including shock, and outlines the role of mechanical circulatory support, including veno-arterial extracorporeal membrane oxygenation (VA-ECMO). Finally, it offers additional recommendations for navigating delivery in women who experienced pregnancy-associated myocardial infarction and considerations for the post-partum patient who develops ACS.
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10
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Majdevac S, Susak S, Vujic V, Okiljevic B, Golubovic M, Zdravkovic R. Management of mechanical aortic valve thrombosis during the first trimester of pregnancy. J Card Surg 2022; 37:1776-1778. [PMID: 35294069 DOI: 10.1111/jocs.16416] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2022] [Revised: 02/19/2022] [Accepted: 02/22/2022] [Indexed: 11/28/2022]
Abstract
BACKGROUND Cardiovascular diseases are the leading cause of morbidity and mortality in pregnant women. On the other hand, cardiac surgery is not so common for pregnant women. CASE REPORT We present the case of a pregnant woman with diagnosed thrombosis of the mechanical aortic valve in the 12th gestational week. The patient underwent surgery, and successfully completed her pregnancy till the 37th gestational week. CONCLUSION We showed that, despite general anaesthesia during the first trimester of pregnancy, the application of the nonpulsatile flow of extracorporeal circulation and mild hypothermia, the operation was successfully completed and that both mother and fetus survived.
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Affiliation(s)
- Slavica Majdevac
- Institute of Cardiovascular Diseases of Vojvodina, Clinic for Cardiovascular Surgery, Sremska Kamenica, Serbia
| | - Stamenko Susak
- Institute of Cardiovascular Diseases of Vojvodina, Clinic for Cardiovascular Surgery, Sremska Kamenica, Serbia.,Faculty of Medicine, University of Novi Sad, Novi Sad, Serbia
| | - Vanja Vujic
- Institute of Cardiovascular Diseases of Vojvodina, Clinic for Cardiovascular Surgery, Sremska Kamenica, Serbia
| | - Bogdan Okiljevic
- Institute of Cardiovascular Diseases of Vojvodina, Clinic for Cardiovascular Surgery, Sremska Kamenica, Serbia.,Faculty of Medicine, University of Novi Sad, Novi Sad, Serbia
| | - Miodrag Golubovic
- Institute of Cardiovascular Diseases of Vojvodina, Clinic for Cardiovascular Surgery, Sremska Kamenica, Serbia.,Faculty of Medicine, University of Novi Sad, Novi Sad, Serbia
| | - Ranko Zdravkovic
- Institute of Cardiovascular Diseases of Vojvodina, Clinic for Cardiovascular Surgery, Sremska Kamenica, Serbia
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11
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OUP accepted manuscript. Eur Heart J 2022; 43:2801-2811. [DOI: 10.1093/eurheartj/ehac234] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Revised: 04/16/2022] [Accepted: 04/24/2022] [Indexed: 11/12/2022] Open
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12
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Lu A, Ye Y, Hu J, Wei N, Wei J, Lin B, Wang S. Case Series: Video-Assisted Minimally Invasive Cardiac Surgery During Pregnancy. Front Med (Lausanne) 2021; 8:781690. [PMID: 35004748 PMCID: PMC8727488 DOI: 10.3389/fmed.2021.781690] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2021] [Accepted: 11/09/2021] [Indexed: 11/16/2022] Open
Abstract
Surgical intervention is expected to improve maternal outcomes in pregnant patients with heart disease once the conservative treatment fails. For pregnant patients with heart disease, the risk of cardiac surgery under cardiopulmonary bypass (CPB) must be balanced due to the high fetal loss. The video-assisted minimally invasive cardiac surgery (MICS) has been progressively applied and shows advantages in non-pregnant patients over the years. We present five cases of pregnant women who underwent a video-assisted minimally invasive surgical approach for cardiac surgery and the management strategies. In conclusion, the video-assisted MICS is feasible and safe to pregnant patients, with good maternal and fetal outcomes under the multidisciplinary assessment and management.
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Affiliation(s)
- Anyi Lu
- Department of Anesthesiology, Guangdong Cardiovascular Institute & Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
- College of Medicine, Shantou University, Shantou, China
| | - Yingxian Ye
- Department of Anesthesiology, Guangdong Cardiovascular Institute & Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Jiaqi Hu
- Department of Anesthesiology, Guangdong Cardiovascular Institute & Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Ning Wei
- Department of Anesthesiology, Guangdong Cardiovascular Institute & Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Jinfeng Wei
- Department of Anesthesiology, Guangdong Cardiovascular Institute & Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Bimei Lin
- Department of Operation Room, Guangdong Cardiovascular Institute & Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Sheng Wang
- Department of Anesthesiology, Guangdong Cardiovascular Institute & Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
- Department of Anesthesiology, Linzhi People's Hospital, Linzhi, China
- *Correspondence: Sheng Wang
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13
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Johnson MZ, Damianopoulos NJ, Lee F, Yong G. Mitral valve-in-valve implantation during pregnancy. BMJ Case Rep 2021; 14:e244270. [PMID: 34815226 PMCID: PMC8611431 DOI: 10.1136/bcr-2021-244270] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/19/2021] [Indexed: 11/03/2022] Open
Abstract
A 32-year-old, 11-week pregnant African woman with known rheumatic heart disease presented to the emergency department with worsening shortness of breath on exertion. She had undergone a double bioprosthetic valve replacement and left atrial appendage resection 8 years prior for severe mitral stenosis, moderate mitral regurgitation and moderate aortic regurgitation. A transo-oesophageal echocardiography at this presentation confirmed a morphologically calcified and stenosed mitral bioprosthesis, with moderate stenosis of her aortic bioprosthesis. Her multidisciplinary team, including cardiologists, cardiothoracic surgeons and obstetricians, came to a consensus decision to proceed with a transseptal transcatheter valve implantation within the mitral valve prosthesis (valve-in-valve implantation). Transthoracic echocardiography performed 2 months post procedure showed satisfactory mitral valve gradients and at 30 weeks' gestation, she successfully delivered her fifth child. 2 years later, the valve in valve complex is still functioning well.
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Affiliation(s)
- Mark Zachary Johnson
- Anaesthetics, Fiona Stanley Hospital, Murdoch, Western Australia, Australia
- Faculty of Medicine Dentistry and Health Sciences, The University of Western Australia, Perth, Western Australia, Australia
| | - Nicholas James Damianopoulos
- Faculty of Medicine Dentistry and Health Sciences, The University of Western Australia, Perth, Western Australia, Australia
| | - Felicity Lee
- Cardiology Dapartment, Fiona Stanley Hospital, Murdoch, Western Australia, Australia
| | - Gerald Yong
- Cardiology Dapartment, Fiona Stanley Hospital, Murdoch, Western Australia, Australia
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14
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Rajasekaran P, Gandhi P, Idhrees M, Velayudhan BV. Aortic complications in pregnancy: the less remembered chapter—a narrative review. EXPLORATION OF MEDICINE 2021. [DOI: 10.37349/emed.2021.00060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Pregnancy increases the risk of common vascular events and also the rarer events like aortic dissection (AD)/aortic rupture and this is even more pronounced in patients with predisposing aortopathies. AD was found to occur in 0.0004% of all pregnancies, and it is more pronounced in patients with underlying connective tissue disorders. The normal hemodynamic changes on a weak aorta will lead to AD and/or rupture, more so with increase in the period of gestation. Hence the haemodynamic and hormonal changes during pregnancy make pregnancy itself a risk factor for AD. It is advised that women with Marfan syndrome who are planning pregnancy should go through prophylactic aortic repair if the diameter of the ascending aorta exceeds 4 cm. Pre-pregnancy counselling is very important in these patients and must include complete history taking, including family history, physical examination and advanced aortic imaging. There is a general consensus among various authors advising against surgery during pregnancy in stable patients due to increased maternal and fetal morbidity but it is justified if the condition is refractory to medical management or in life threatening stage like acute AD. Though the incidence of aortopathy in pregnancy is rare, there is a high maternal and fetal mortality associated with this condition.
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Affiliation(s)
- Preetha Rajasekaran
- Department of Obstetrics and Gynaecology, Vihaa Hospitals, Anna Nagar, Chennai-600102, India
| | - Praveena Gandhi
- Department of Obstetrics and Gynaecology PPN Hospital, Palani-624601, India
| | - Mohammed Idhrees
- Institute of Cardiac and Aortic Diseases, SIMS hospital, Chennai-600026, India
| | - Bashi V. Velayudhan
- Institute of Cardiac and Aortic Diseases, SIMS hospital, Chennai-600026, India
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15
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Cho L, Kibbe MR, Bakaeen F, Aggarwal NR, Davis MB, Karmalou T, Lawton JS, Ouzounian M, Preventza O, Russo AM, Shroyer ALW, Zwischenberger BA, Lindley KJ. Cardiac Surgery in Women in the Current Era: What Are the Gaps in Care? Circulation 2021; 144:1172-1185. [PMID: 34606298 DOI: 10.1161/circulationaha.121.056025] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
Cardiovascular disease remains the leading cause of morbidity and mortality for women in United States and worldwide. One in 3 women dies from cardiovascular disease, and 45% of women >20 years old have some form of CVD. Historically, women have had higher morbidity and mortality after cardiac surgery. Sex influences pathogenesis, pathophysiology, presentation, postoperative complications, surgical outcomes, and survival. This review summarizes current cardiovascular surgery outcomes as they pertain to women. Specifically, this article seeks to address whether sex disparities in research, surgical referral, and outcomes still exist and to provide strategies to close these gaps. In addition, with the growing population of women of reproductive age with cardiovascular disease and cardiovascular risk factors, indications for cardiac surgery arise in pregnant women. The current review will also address the unique issues associated with this special population.
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Affiliation(s)
- Leslie Cho
- Cleveland Clinic Heart and Vascular Institute, Ohio (L.C., F.B.,T.K.)
| | - Melina R Kibbe
- University of North Caroline Medical School, Chapel Hill (M.R.K.)
| | - Faisal Bakaeen
- Cleveland Clinic Heart and Vascular Institute, Ohio (L.C., F.B.,T.K.)
| | | | | | - Tara Karmalou
- Cleveland Clinic Heart and Vascular Institute, Ohio (L.C., F.B.,T.K.)
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16
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Merlo AC, Rosa GM, Porto I. Pregnancy-related acute myocardial infarction: a review of the recent literature. Clin Res Cardiol 2021; 111:723-731. [PMID: 34510263 PMCID: PMC9242969 DOI: 10.1007/s00392-021-01937-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Accepted: 08/30/2021] [Indexed: 12/18/2022]
Abstract
Pregnancy-related acute myocardial infarction is a rare and potentially life-threatening cardiovascular event, the incidence of which is growing due to the heightened prevalence of several risk factors, including increased maternal age. Its main aetiology is spontaneous coronary artery dissection, which particularly occurs in pregnancy and may engender severe clinical scenarios. Therefore, despite frequently atypical and deceptive presentations, early recognition of such a dangerous complication of gestation is paramount. Notwithstanding diagnostic and therapeutic improvements, pregnancy-related acute myocardial infarction often carries unfavourable outcomes, as emergent management is difficult owing to significant limitations in the use of ionising radiation-e.g. during coronary angiography, potentially harmful to the foetus even at low doses. Notably, however, maternal mortality has steadily decreased in recent decades, indicating enhanced awareness and major medical advances in this field. In our paper, we review the recent literature on pregnancy-related acute myocardial infarction and highlight the key points in its management.
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Affiliation(s)
- Andrea Carlo Merlo
- Department of Internal Medicine and Medical Specialties (DIMI), Chair of Cardiovascular Diseases, University of Genoa, Genoa, Italy
| | - Gian Marco Rosa
- Department of Internal Medicine and Medical Specialties (DIMI), Chair of Cardiovascular Diseases, University of Genoa, Genoa, Italy
- Cardiology Unit, DICATOV-Cardiothoracic and Vascular Department, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Italo Porto
- Department of Internal Medicine and Medical Specialties (DIMI), Chair of Cardiovascular Diseases, University of Genoa, Genoa, Italy.
- Cardiology Unit, DICATOV-Cardiothoracic and Vascular Department, IRCCS Ospedale Policlinico San Martino, Genoa, Italy.
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17
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Pregnancy-Associated Myocardial Infarction: A Review of Current Practices and Guidelines. Curr Cardiol Rep 2021; 23:142. [PMID: 34410528 DOI: 10.1007/s11886-021-01579-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/10/2021] [Indexed: 12/12/2022]
Abstract
PURPOSE OF REVIEW Pregnancy-associated myocardial infarction is a principal cause of cardiovascular disease with a steadily rising incidence of 4.98 AMI events/100,000 deliveries over the last four decades in the USA. It is also linked with significant maternal and fetal morbidity and mortality, with maternal case fatality rate ranging from 5.1 to 37%. The management of acute myocardial infarction can be challenging in pregnant patients since treatment modalities and medication use are limited by their safety during pregnancy. RECENT FINDINGS Limited guidelines exist regarding the management of pregnancy-associated myocardial infarction. Routinely used medications in myocardial infarction including angiotensin-converting enzyme inhibitors (ACEI), angiotensin receptor blockers (ARB), and statin therapy are contraindicated during pregnancy. Aspirin use is considered safe in pregnant women, but dual antiplatelet therapy and therapeutic anticoagulation can be associated with increased risk of maternal and fetal complications, and should only be used after a comprehensive benefit-to-risk assessment. The standard approach to revascularization requires additional caution in pregnant women. Percutaneous coronary intervention is generally considered safe but can be associated with high failure rates and poor outcomes depending on the etiology. Fibrinolytic therapy may have significant sequelae in pregnant patients, and hemodynamic management during surgery is complex and adds risk during pregnancy. Understanding the risks and benefits of the different treatment modalities available and their utility depending on the underlying etiology, encompassed with a multidisciplinary team approach, is vital to improve outcomes and minimize maternal and fetal complications.
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18
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Chavez P, Wolfe D, Bortnick AE. Management of Ischemic Heart Disease in Pregnancy. Curr Atheroscler Rep 2021; 23:52. [PMID: 34268620 PMCID: PMC8528181 DOI: 10.1007/s11883-021-00944-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/10/2021] [Indexed: 10/20/2022]
Abstract
PURPOSE OF REVIEW Cardiovascular disease is an escalating cause of maternal morbidity and mortality. Women are at risk for acute myocardial infarction (MI), and more are living with risk factors for ischemic heart disease (IHD). The purpose of this review is to describe the evaluation and management of women at risk for and diagnosed with IHD in pregnancy. RECENT FINDINGS Pregnancy can provoke MI which has been estimated as occurring in 1.5-10/100, 000 deliveries or 1/12,400 hospitalizations, with a high inpatient mortality rate of approximately 5-7%. An invasive strategy may or may not be preferred, but fetal radiation exposure is less of a concern in comparison to maternal mortality. Common medications used to treat IHD may be continued successfully during pregnancy and lactation, including aspirin, which has an emerging role in pregnancy to prevent preeclampsia, preterm labor, and maternal mortality. Hemodynamics can be modulated during pregnancy, labor, and postpartum to mitigate risk for acute decompensation in women with IHD. Cardiologists can successfully manage IHD in pregnancy with obstetric partners and should engage women in a lifetime of cardiovascular care.
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Affiliation(s)
- Patricia Chavez
- Division of Cardiology, Department of Medicine, Montefiore Medical Center and Albert Einstein College of Medicine, Bronx, New York, USA
| | - Diana Wolfe
- Division of Cardiology, Department of Medicine, Montefiore Medical Center and Albert Einstein College of Medicine, Bronx, New York, USA.,Department of Obstetrics & Gynecology and Women's Health (Maternal Fetal Medicine), Montefiore Medical Center and Albert Einstein College of Medicine, Bronx, New York, USA.,Maternal Fetal Medicine & Cardiology Joint Program, Montefiore Medical Center and Albert Einstein College of Medicine, Bronx, New York, USA
| | - Anna E Bortnick
- Division of Cardiology, Department of Medicine, Montefiore Medical Center and Albert Einstein College of Medicine, Bronx, New York, USA. .,Maternal Fetal Medicine & Cardiology Joint Program, Montefiore Medical Center and Albert Einstein College of Medicine, Bronx, New York, USA. .,Division of Geriatrics, Department of Medicine, Montefiore Medical Center and Albert Einstein College of Medicine, Bronx, New York, USA. .,Jack D. Weiler Hospital, 1825 Eastchester Road Suite 2S-46 Bronx, New York, NY, 10461, USA.
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19
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de Marvao A, Alexander D, Bucciarelli-Ducci C, Price S. Heart disease in women: a narrative review. Anaesthesia 2021; 76 Suppl 4:118-130. [PMID: 33682102 DOI: 10.1111/anae.15376] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/08/2020] [Indexed: 12/12/2022]
Abstract
Cardiovascular disease is the worldwide leading cause of death in women. Biological differences between the sexes, a result of genetic, epigenetic and sex hormone-mediated factors, are complex and incompletely understood. These differences are compounded by socio-cultural factors and together account for the variation in the prevalence, presentation and natural history of cardiovascular disease between men and women. Although there is growing recognition of sex-specific determinants of outcomes, women remain under-represented in clinical trials, and sex-disaggregated diagnostic and management strategies are not currently recommended in clinical guidelines. Women remain more likely to experience delays in diagnosis, to be treated less aggressively and to have worse outcomes. As a consequence, cardiovascular disease in women remains understudied, underdiagnosed and undertreated. This review will focus on female-specific characteristics of cardiovascular disease and how these may impact on anaesthetic and peri-operative risk assessment and care. We highlight significant differences between the sexes in the natural history of cardiovascular disease, including those disease entities that are more common in women, such as sudden coronary artery dissection or microvascular dysfunction. Given the rapidly rising incidence of maternal cardiovascular disease and associated complications, special consideration is given to the risk assessment and management of these conditions during pregnancy. Increased awareness of these issues has the potential to improve the effectiveness of the multidisciplinary heart team and ultimately improve the care provided to women.
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Affiliation(s)
- A de Marvao
- MRC London Institute of Medical Sciences, Imperial College London, London, UK
| | - D Alexander
- Department of Cardiac Anaesthesia, Royal Brompton Hospital, London, UK
| | - C Bucciarelli-Ducci
- Bristol Heart Institute, Bristol NIHR Cardiovascular Research Centre, University of Bristol and University Hospitals Bristol NHS Trust, Bristol, UK
| | - S Price
- Adult Intensive Care Unit, Royal Brompton Hospital, London, UK.,National Heart and Lung Institute, Imperial College, London, UK
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20
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21
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Campbell KH, Tweet MS. Coronary Disease in Pregnancy: Myocardial Infarction and Spontaneous Coronary Artery Dissection. Clin Obstet Gynecol 2020; 63:852-867. [PMID: 32701519 PMCID: PMC10767871 DOI: 10.1097/grf.0000000000000558] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Pregnancy-related maternal mortality and morbidity rates continue to increase in the United States despite global improvements in maternal outcomes. The unique hemodynamic and physiological changes of pregnancy results in a 3- to 4-fold increased risk of acute myocardial infarction (AMI) which causes a substantial proportion of all maternal cardiac deaths. In addition to atherosclerosis, pregnancy-associated AMI is commonly caused by nonatherosclerotic etiologies such as spontaneous coronary artery dissection, embolus to the coronary artery, and coronary vasospasm. Herein, the epidemiology, etiologies, presentation, diagnosis, and management of AMI in pregnancy is discussed along with future directions for multidisciplinary care.
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Affiliation(s)
- Katherine H Campbell
- Department of Obstetrics, Gynecology and Reproductive Sciences, Yale School of Medicine, New Haven, Connecticut
| | - Marysia S Tweet
- Department of Cardiovascular Diseases, Mayo Clinic College of Medicine and Science, Rochester, Minnesota
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22
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Carlier L, Devroe S, Budts W, Van Calsteren K, Rega F, Van de Velde M, Rex S. Cardiac interventions in pregnancy and peripartum – a narrative review of the literature. J Cardiothorac Vasc Anesth 2020; 34:3409-3419. [DOI: 10.1053/j.jvca.2019.12.021] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2019] [Revised: 11/19/2019] [Accepted: 12/12/2019] [Indexed: 12/17/2022]
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23
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Abstract
Valvular heart disease (VHD) is generally well tolerated during pregnancy; however, the dramatic changes in hemodynamics that occur during pregnancy can lead to clinical decompensation in high-risk women. Women with VHD considering pregnancy should undergo preconception counseling with a high-risk obstetrician and cardiologist to review the maternal, fetal, and obstetric risks of pregnancy and delivery. Vaginal delivery is recommended for most women with VHD. Given the complexity of managing VHD during pregnancy, women should be managed by a multidisciplinary Pregnancy Heart Team during pregnancy, consisting of a high-risk obstetrician, cardiologist, and cardiac anesthesiologist.
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Affiliation(s)
- Jennifer Lewey
- Division of Cardiology, Department of Medicine, University of Pennsylvania Perelman School of Medicine, Perelman Center for Advanced Medicine, 3400 Civic Center Boulevard, 2-East Pavilion, Philadelphia, PA 19104, USA.
| | - Lauren Andrade
- Philadelphia Adult Congenital Heart Center, University of Pennsylvania, Children's Hospital of Philadelphia, Perelman Center for Advanced Medicine, 3400 Civic Center Boulevard, 2- East Pavilion, Philadelphia, PA 19104, USA
| | - Lisa D Levine
- Department of Obstetrics and Gynecology, Maternal and Child Health Research Center, University of Pennsylvania Perelman School of Medicine, 3400 Spruce Street, 2 Silverstein, Philadelphia, PA 19104, USA
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24
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Chin JM, Bartholomew ML. Aortic aneurysm and dissection in pregnancy: A case report. Case Rep Womens Health 2020; 28:e00261. [PMID: 33083238 PMCID: PMC7554023 DOI: 10.1016/j.crwh.2020.e00261] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2020] [Revised: 09/26/2020] [Accepted: 09/30/2020] [Indexed: 11/29/2022] Open
Abstract
We describe a 24-year-old pregnant woman at 34 weeks of gestation who presented to a community hospital with sharp chest pain radiating to her back. She was found to have a 6 cm ascending aortic aneurysm despite not having any established risk factors. She was transported by air ambulance to a tertiary-care hospital. She delivered a live female neonate via cesarean delivery. Her postpartum course was notable for multiple episodes of chest pain and multiple imaging studies that were read as negative for aortic dissection. Definitive valve surgery was postponed by the cardiothoracic surgeons to allow for recovery from severe preeclampsia, treatment of endometritis, and due to concerns for uterine bleeding while on anticoagulation during cardiopulmonary bypass. She was eventually transferred to another hospital in another state for valve-sparing surgery. During transport, she developed a pulmonary embolism, and after arrival an aortic dissection was confirmed. She received a mechanical aortic valve replacement and the aneurysm was repaired. She returned home and recovered without complication. A gene panel revealed a heterozygous pathogenic variant of the Filamin A gene. Aortic aneurysms during pregnancy are rare, and aortic dissections are more rare. We recommend expeditious surgical treatment, a heightened index of suspicion, and testing for a genetic cause of aneurysm when diagnosed in a pregnant or postpartum woman with no known risk factors. Aortic aneurysm in pregnancy is rare and mortality is high. Genetic testing should be performed with a new diagnosis of aortic aneurysm. Multidisciplinary care is essential for aortic aneurysm in pregnancy.
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Affiliation(s)
- Jennifer M Chin
- University of Hawaii, Department of Obstetrics, Gynecology, and Women's Health, 1319 Punahou St, Ste 824, Honolulu, HI 96826, USA
| | - Marguerite L Bartholomew
- University of Hawaii, Department of Obstetrics, Gynecology, and Women's Health, 1319 Punahou St, Ste 824, Honolulu, HI 96826, USA
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25
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Avila WS, Alexandre ERG, Castro MLD, Lucena AJGD, Marques-Santos C, Freire CMV, Rossi EG, Campanharo FF, Rivera IR, Costa MENC, Rivera MAM, Carvalho RCMD, Abzaid A, Moron AF, Ramos AIDO, Albuquerque CJDM, Feio CMA, Born D, Silva FBD, Nani FS, Tarasoutchi F, Costa Junior JDR, Melo Filho JXD, Katz L, Almeida MCC, Grinberg M, Amorim MMRD, Melo NRD, Medeiros OOD, Pomerantzeff PMA, Braga SLN, Cristino SC, Martinez TLDR, Leal TDCAT. Brazilian Cardiology Society Statement for Management of Pregnancy and Family Planning in Women with Heart Disease - 2020. Arq Bras Cardiol 2020; 114:849-942. [PMID: 32491078 PMCID: PMC8386991 DOI: 10.36660/abc.20200406] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Affiliation(s)
- Walkiria Samuel Avila
- Instituto do Coração (Incor) do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HC-FMUSP),São Paulo, SP - Brasil
| | | | - Marildes Luiza de Castro
- Hospital das Clínicas da Faculdade de Medicina da Universidade Federal de Minas gerais (UFMG),Belo Horizonte, MG - Brasil
| | | | - Celi Marques-Santos
- Universidade Tiradentes,Aracaju, SE - Brasil.,Hospital São Lucas, Rede D'Or Aracaju,Aracaju, SE - Brasil
| | | | - Eduardo Giusti Rossi
- Instituto do Coração (Incor) do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HC-FMUSP),São Paulo, SP - Brasil
| | - Felipe Favorette Campanharo
- Universidade Federal de São Paulo (UNIFESP), Escola Paulista de Medicina (EPM),São Paulo, SP - Brasil.,Hospital Israelita Albert Einstein,São Paulo, SP - Brasil
| | | | - Maria Elizabeth Navegantes Caetano Costa
- Cardio Diagnóstico,Belém, PA - Brasil.,Centro Universitário Metropolitano da Amazônia (UNIFAMAZ),Belém, PA - Brasil.,Centro Universitário do Estado Pará (CESUPA),Belém, PA - Brasil
| | | | | | - Alexandre Abzaid
- Instituto do Coração (Incor) do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HC-FMUSP),São Paulo, SP - Brasil
| | - Antonio Fernandes Moron
- Universidade Federal de São Paulo (UNIFESP), Escola Paulista de Medicina (EPM),São Paulo, SP - Brasil
| | | | - Carlos Japhet da Mata Albuquerque
- Instituto de Medicina Integral Professor Fernando Figueira (IMIP), Recife, PE – Brazil,Hospital Barão de Lucena, Recife, PE – Brazil,Hospital EMCOR, Recife, PE – Brazil,Diagnósticos do Coração LTDA, Recife, PE – Brazil
| | | | - Daniel Born
- Universidade Federal de São Paulo (UNIFESP), Escola Paulista de Medicina (EPM),São Paulo, SP - Brasil
| | | | - Fernando Souza Nani
- Instituto do Coração (Incor) do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HC-FMUSP),São Paulo, SP - Brasil
| | - Flavio Tarasoutchi
- Instituto do Coração (Incor) do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HC-FMUSP),São Paulo, SP - Brasil
| | - José de Ribamar Costa Junior
- Hospital do Coração (HCor),São Paulo, SP - Brasil.,Instituto Dante Pazzanese de Cardiologia,São Paulo, SP - Brasil
| | | | - Leila Katz
- Instituto de Medicina Integral Professor Fernando Figueira (IMIP), Recife, PE – Brazil
| | | | - Max Grinberg
- Instituto do Coração (Incor) do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HC-FMUSP),São Paulo, SP - Brasil
| | | | - Nilson Roberto de Melo
- Departamento de Obstetrícia e Ginecologia da Faculdade de Medicina da Universidade de São Paulo (USP), São Paulo, SP – Brazil
| | | | - Pablo Maria Alberto Pomerantzeff
- Instituto do Coração (Incor) do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HC-FMUSP),São Paulo, SP - Brasil
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26
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Interventional Cardiology and Catheter-Based Interventions in Pregnancy. Cardiol Rev 2020; 30:24-30. [PMID: 33027066 DOI: 10.1097/crd.0000000000000361] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Cardiovascular disease is the leading cause of maternal mortality worldwide and has been increasing in prevalence over the last several decades. Pregnancy is associated with significant hemodynamic changes that can overwhelm the maternal cardiovascular reserve, and may exacerbate previously asymptomatic cardiovascular disease. Complications associated with these may cause substantial harm to both the mother and the fetus, and the management of these conditions is often challenging. Numerous novel treatments and interventions have demonstrated the safety and efficacy of managing these conditions outside of pregnancy. However, there are little data regarding their use in the pregnant population. In this review, we describe the common cardiovascular diseases encountered during pregnancy and discuss their management strategies, with a particular focus on the role of percutaneous, catheter-based therapeutic interventions.
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27
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Pillot R, Pouypoudat L, Morel O, Chamagne M. [Infective endocarditis during pregnancy]. GYNECOLOGIE, OBSTETRIQUE, FERTILITE & SENOLOGIE 2020; 48:710-712. [PMID: 32234385 DOI: 10.1016/j.gofs.2020.03.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/15/2020] [Indexed: 06/11/2023]
Affiliation(s)
- R Pillot
- Maternité régionale universitaire de Lorraine, 10, avenue Dr Heydenreich, 54000 Nancy, France.
| | - L Pouypoudat
- Maternité régionale universitaire de Lorraine, 10, avenue Dr Heydenreich, 54000 Nancy, France
| | - O Morel
- Maternité régionale universitaire de Lorraine, 10, avenue Dr Heydenreich, 54000 Nancy, France
| | - M Chamagne
- Maternité régionale universitaire de Lorraine, 10, avenue Dr Heydenreich, 54000 Nancy, France
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28
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Gupta R, Malik AH, Ranchal P, Aronow WS, Vyas AV, Rajeswaran Y, Quinones J, Ahnert AM. Valvular Heart Disease in Pregnancy: Anticoagulation and the Role of Percutaneous Treatment. Curr Probl Cardiol 2020; 46:100679. [PMID: 32868039 DOI: 10.1016/j.cpcardiol.2020.100679] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2020] [Accepted: 07/26/2020] [Indexed: 10/23/2022]
Abstract
Valvular heart disease is present in about 1% of pregnancies, and it poses a management challenge as both fetal and maternal lives are at risk of complications. Pregnancy is associated with significant hemodynamic changes, which can compromise the cardiac status in women with underlying valvular disorders. Management of valvular heart diseases has undergone considerable innovation and advancement with newer techniques, approaches and devices being employed. The decision regarding the management of anticoagulation, especially in patients with prosthetic valves, raises distinct questions and challenges. In this review, we describe the management of common valvular heart diseases encountered during pregnancy, role of percutaneous catheter based therapeutic interventions, the importance of a team-based approach, and the challenges given existing gaps in the literature.
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Affiliation(s)
- Rahul Gupta
- Lehigh Valley Heart Institute, Lehigh Valley Health Network, Allentown, PA.
| | - Aaqib H Malik
- Department of Cardiology, Westchester Medical Center and New York Medical College, Valhalla, NY
| | - Purva Ranchal
- Department of Internal Medicine, Boston University, MA
| | - Wilbert S Aronow
- Department of Cardiology, Westchester Medical Center and New York Medical College, Valhalla, NY
| | - Apurva V Vyas
- Lehigh Valley Heart Institute, Lehigh Valley Health Network, Allentown, PA.
| | - Yasotha Rajeswaran
- Lehigh Valley Heart Institute, Lehigh Valley Health Network, Allentown, PA.
| | - Joanne Quinones
- Lehigh Valley Heart Institute, Lehigh Valley Health Network, Allentown, PA.
| | - Amy M Ahnert
- Lehigh Valley Heart Institute, Lehigh Valley Health Network, Allentown, PA.
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29
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Fraccaro C, Tence N, Masiero G, Karam N. Management of Valvular Disease During Pregnancy: Evolving Role of Percutaneous Treatment. ACTA ACUST UNITED AC 2020; 15:e10. [PMID: 32905129 PMCID: PMC7463339 DOI: 10.15420/icr.2020.06] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2020] [Accepted: 05/11/2020] [Indexed: 12/14/2022]
Abstract
Valvular heart disease (VHD) is encountered in approximately 1% of pregnancies, significantly increasing both maternal and foetal risk. Rheumatic VHD remains the most common form in non-Western countries, whereas congenital heart disease dominates in the Western world. The risk of complications varies according to the type and severity of the underlying VHD. Moreover, pregnancy is a hypercoagulable state associated with increased risk of thromboembolism. The authors review the main VHDs encountered during pregnancy, and suggest management strategies based on the 2018 European Society of Cardiology recommendations for the management of pregnant women with VHD, providing an overview of classical and new transcatheter structural therapeutic options with a special focus on radiation exposure and anticoagulation drug management.
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Affiliation(s)
- Chiara Fraccaro
- Interventional Cardiology Unit, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua Padua, Italy
| | - Noemie Tence
- Medico-Surgical Heart Valve Unit, Georges Pompidou European Hospital, University of Paris Paris, France
| | - Giulia Masiero
- Interventional Cardiology Unit, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua Padua, Italy
| | - Nicole Karam
- Medico-Surgical Heart Valve Unit, Georges Pompidou European Hospital, University of Paris Paris, France
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30
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Adesomo A, Gonzalez-Brown V, Rood KM. Infective Endocarditis as a Complication of Intravenous Drug Use in Pregnancy: A Retrospective Case Series and Literature Review. AJP Rep 2020; 10:e288-e293. [PMID: 33274121 PMCID: PMC7704245 DOI: 10.1055/s-0040-1716732] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2020] [Accepted: 06/04/2020] [Indexed: 01/04/2023] Open
Abstract
Objective An increase in opioid use disorder and subsequent intravenous drug use has led to an increase in sequalae that may complicate pregnancy, such as infective endocarditis. Infective endocarditis has the potential for significant maternal and neonatal morbidity and mortality. We sought to examine the management considerations and clinical implications of intravenous drug use-related infective endocarditis in pregnancy from our center's experience. Study Design Retrospective study of management of pregnancies complicated by infective endocarditis as a result of active intravenous drug use at an academic tertiary care hospital from January 2012 through December 2019. Results Twelve women with active intravenous drug use histories were identified as having clinical and echocardiographic features consistent with infective endocarditis. Six women were discharged against medical advice and did not complete the full course of recommended antibiotic regimen. Eight women were started or continued on opioid agonist therapy during their hospitalization. Four neonates required neonatal intensive care unit admission for pharmacologic treatment for neonatal abstinence syndrome. Conclusion Management of intravenous drug use-associated infective endocarditis in pregnancy involves more than treating the acute condition. In pregnant women with opioid use disorder and infective endocarditis, addiction and chronic psychosocial conditions need to be addressed to optimize care.
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Affiliation(s)
- Adebayo Adesomo
- Department of Obstetrics and Gynecology, The Ohio State University College of Medicine, Columbus, Ohio
| | - Veronica Gonzalez-Brown
- Department of Obstetrics and Gynecology, The Ohio State University College of Medicine, Columbus, Ohio
| | - Kara M Rood
- Department of Obstetrics and Gynecology, The Ohio State University College of Medicine, Columbus, Ohio
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Wang J, Lu J. Anesthesia for Pregnant Women with Pulmonary Hypertension. J Cardiothorac Vasc Anesth 2020; 35:2201-2211. [PMID: 32736999 DOI: 10.1053/j.jvca.2020.06.062] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Revised: 06/14/2020] [Accepted: 06/16/2020] [Indexed: 12/12/2022]
Abstract
Despite advances in the therapy for pulmonary hypertension over the past decades, the prognosis of pregnant patients with pulmonary hypertension remains poor, with high maternal mortality. This poses a particular challenge for the mother and her medical team. In the present review, the authors have updated the classification and definition of pulmonary hypertension, summarized the current knowledge with regard to perioperative management and anesthesia considerations for these patients, and stressed the importance of a "pregnancy heart team" to improve long-term outcomes of pregnant women with pulmonary hypertension.
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Affiliation(s)
- Jiawan Wang
- Department of Anesthesiology, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
| | - Jiakai Lu
- Department of Anesthesiology, Beijing An-Zhen Hospital, Capital Medical University, Beijing Institute of Heart, Lung, and Blood Vessel Diseases, Beijing, China.
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Patel C, Akhtar H, Gupta S, Harky A. Pregnancy and cardiac interventions: What are the optimal management options? J Card Surg 2020; 35:1589-1596. [PMID: 32484993 DOI: 10.1111/jocs.14637] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Cardiac disease is the leading cause of maternal mortality in the United Kingdom. Major causes of cardiac death in pregnant women include cardiomyopathies, myocardial infarction, ischemic heart disease, and aortic dissection. Uncorrected congenital heart disease and women who have had corrective or palliative surgery may have complicated pregnancies as well. Some women with significant cardiac disease are unable to meet the increased physiological demands of pregnancy. Of these, those who do not respond to medical treatment may require surgical correction such as coronary artery bypass grafting. The risk of cardiac operations for pregnant women is similar to that for nonpregnant women but the fetal mortality rate remains high. Contributing factors to high fetal mortality rates include timing, urgency of operation, and the fetal/fetoplacental response to cardiopulmonary bypass. The aim of this review is to summarize current evidence in utilizing the different management approaches of cardiac issues during pregnancy.
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Affiliation(s)
- Chandni Patel
- Department of Medicine, St George's University of London, London, UK
| | - Hubba Akhtar
- Department of Medicine, St George's University of London, London, UK
| | - Shubhi Gupta
- Department of Medicine, University of Liverpool, Liverpool, UK
| | - Amer Harky
- Department of Cardiothoracic Surgery, Liverpool Heart and Chest Hospital, Liverpool, UK
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Wang J, Wang A, Cui Y, Wang C, Zhang J. Diagnosis and treatment of infective endocarditis in pregnancy: a case report. J Cardiothorac Surg 2020; 15:109. [PMID: 32448305 PMCID: PMC7245794 DOI: 10.1186/s13019-020-01147-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2019] [Accepted: 05/10/2020] [Indexed: 11/10/2022] Open
Abstract
Background Pregnancy with infective endocarditis (IE) is rare, but the fetal and maternal mortality rates of these pregnancies are very high, making IE a serious threat to the safety of pregnant women and their fetuses. Therefore, for pregnant women with recurrent fever, a detailed medical history and physical examination should be performed, echocardiography and blood culture should be carried out as soon as possible, multidisciplinary consultation should be implemented, and a diagnosis and treatment plan should be formulated right away, as this is key to saving the lives of mothers and infants. Case introduction A 30-year-old pregnant Chinese woman had IE at 26 weeks of gestation. After close monitoring and care until 31 weeks of gestation, she underwent a successful delivery, cardiac surgery, repair of the patent ductus arteriosus (PDA), mitral valvuloplasty (MVP) and removal of the vegetations. The operation was successful, and further follow-up evaluation showed no abnormality. Conclusion For the diagnosis and treatment of IE in pregnancy, it is of great importance to implement an individualized diagnosis and treatment plan in combination with close monitoring by echocardiography and to select the right time for cardiac surgery and termination of pregnancy.
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Affiliation(s)
- Jing Wang
- Department of Ultrasound, Zhejiang Provincial People's Hospital, People's Hospital of HangZhou Medical College, Hangzhou, 310014, Zhejiang, China
| | - Anlong Wang
- Department of Radiology, Zhejiang Provincial Integrated Chinese and Western Medicine Hospital, Hangzhou Red Cross Hospital, Hangzhou, China
| | - Yong Cui
- Department of Cardiothoracic Surgery, Zhejiang Provincial People's Hospital, People's Hospital of HangZhou Medical College, Hangzhou, China
| | - Ceng Wang
- Department of Ultrasound, Zhejiang Provincial People's Hospital, People's Hospital of HangZhou Medical College, Hangzhou, 310014, Zhejiang, China
| | - Jian Zhang
- Department of Ultrasound, Zhejiang Provincial People's Hospital, People's Hospital of HangZhou Medical College, Hangzhou, 310014, Zhejiang, China.
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34
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Chloropoulou PP, Konstantinou F, Nikitidis N, Tsikouras P, Vogiatzaki T. Anesthetic Management of a Parturient With Cardiac Tamponade due to Heart Perforation by an Atrial Septum Defect Repair Device. A A Pract 2020; 14:116-118. [DOI: 10.1213/xaa.0000000000001161] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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35
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Anesthetic Management of a Voluminous Left Atrial Myxoma Resection in a 19 Weeks Pregnant with Atypical Clinical Presentation. Case Rep Anesthesiol 2019; 2019:4181502. [PMID: 31934456 PMCID: PMC6942744 DOI: 10.1155/2019/4181502] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2019] [Accepted: 11/20/2019] [Indexed: 11/17/2022] Open
Abstract
We report the case of a semi-urgent cardiac surgery, in a 19 gestation age pregnant. Despite the fact that the patient was asymptomatic, except for some palpitations, a large left auricle (LA) myxoma was fortuitously diagnosed with transthoracic echocardiography (TEE). Considering the important embolic risk, the tumor was successfully removed during cardiac surgery under cardiopulmonary bypass (CPB). Fetal bradycardia following defibrillation under stable maternal and CPB conditions was successfully managed. The postoperative period and remainder of the pregnancy was smooth and the delivery uneventful.
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Abstract
One percent to 2% of pregnant women undergo nonobstetric surgery during pregnancy. Historically, there has been a reluctance to operate on pregnant women based on concerns for teratogenesis, pregnancy loss, or preterm birth. However, a careful review of published data suggests four major flaws affecting much of the available literature. Many studies contain outcomes data from past years in which diagnostic testing, surgical technique, and perioperative maternal-fetal care were so different from current experience as to make these data of limited utility today. This issue is further compounded by a tendency to combine experience from vastly disparate types of surgery into a single report. In addition, reports in nonobstetric journals often focus on maternal outcomes and contain insufficient detail regarding perinatal outcomes to allow distinction between complications associated with surgical disease and those attributable to surgery itself. Finally, most series are either uncontrolled or use the general population of pregnant women as controls rather than women with surgical disease who are managed nonsurgically. Consideration of these factors as well as our own extensive experience suggests that when the risks of maternal hypotension or hypoxia are minimal, or can be adequately mitigated, indicated surgery during any trimester does not appear to subject either the mother or fetus to risks significantly beyond those associated with the disease itself or the complications of surgery in nonpregnant individuals. In some cases, reluctance to operate during pregnancy becomes a self-fulfilling prophecy in which delay in surgery contributes to adverse perinatal outcomes traditionally attributed to surgery itself.
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37
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Zhong C, Rokey R, Rolak S, Mesa J. Pregnancy and transcatheter aortic valve replacement in a severely stenotic Freestyle full aortic root stentless bioprosthesis. Catheter Cardiovasc Interv 2019; 95:1225-1229. [PMID: 31483554 DOI: 10.1002/ccd.28481] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2019] [Revised: 07/26/2019] [Accepted: 08/20/2019] [Indexed: 12/22/2022]
Abstract
Symptomatic degenerative prosthetic aortic valve stenosis during pregnancy represents a significant risk to both mother and fetus, and until recently, surgical aortic valve replacement (SAVR) during pregnancy was often the only choice for women opting to continue pregnancy. However, symptomatic severe stenosis in a pregnant woman with a degenerated full aortic root Freestyle stentless bioprosthesis (FSB) and reimplanted coronary arteries presents additional complexities that require an alternative surgical approach. In this case report, we describe the first successful transcatheter aortic valve replacement (TAVR) in SAVR for a severely stenotic degenerative FSB in a pregnant woman and subsequent delivery of a healthy infant several months later. TAVR in SAVR of a severely stenotic aortic FSB should be considered as a surgical option in symptomatic pregnant women. Short-term and long-term implications for future pregnancy should be discussed by a multidisciplinary team and with the patient.
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Affiliation(s)
- Chuyang Zhong
- Department of Internal Medicine, Marshfield Medical Center-Marshfield, Marshfield, Wisconsin
| | - Roxann Rokey
- Clinical Research Center, Marshfield Clinic Research Institute, Marshfield, Wisconsin
| | - Stacey Rolak
- University of Wisconsin, School of Medicine and Public Health, Madison, Wisconsin
| | - Juan Mesa
- Cardiology Department, Marshfield Medical Center-Marshfield, Marshfield, Wisconsin
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38
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Maskell P, Burgess M, MacCarthy‐Ofosu B, Harky A. Management of aortic valve disease during pregnancy: A review. J Card Surg 2019; 34:239-249. [DOI: 10.1111/jocs.14039] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2019] [Revised: 03/01/2019] [Accepted: 03/05/2019] [Indexed: 12/15/2022]
Affiliation(s)
- Perry Maskell
- Department of Vascular SurgeryCountess of Chester HospitalChester England
| | - Mika Burgess
- Department of Obstetrics and GynaecologyYsbyty GwyneddBangor Wales
| | | | - Amer Harky
- Department of Vascular SurgeryCountess of Chester HospitalChester England
- School of MedicineUniversity of LiverpoolLiverpool England
- Department of Cardiothoracic SurgeryLiverpool Heart and ChestLiverpool UK
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39
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De Filippo O, Verardi R, Montali N, Marra WG, Omedè P, Presbitero P, Rinaldi M, D'Ascenzo F. You may stay forever young: An editorial regarding management of heart disease in pregnancy. Int J Cardiol 2019; 276:72-73. [PMID: 30470463 DOI: 10.1016/j.ijcard.2018.11.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2018] [Accepted: 11/09/2018] [Indexed: 11/16/2022]
Affiliation(s)
- Ovidio De Filippo
- Division of Cardiology, AOU Città della Salute e della Scienza di Torino, Turin, Italy
| | - Roberto Verardi
- Division of Cardiology, AOU Città della Salute e della Scienza di Torino, Turin, Italy
| | - Nicolò Montali
- Division of Cardiology, AOU Città della Salute e della Scienza di Torino, Turin, Italy
| | - Walter Grosso Marra
- Division of Cardiology, AOU Città della Salute e della Scienza di Torino, Turin, Italy
| | - Pierluigi Omedè
- Division of Cardiology, AOU Città della Salute e della Scienza di Torino, Turin, Italy
| | | | - Mauro Rinaldi
- Division of Cardiology, AOU Città della Salute e della Scienza di Torino, Turin, Italy
| | - Fabrizio D'Ascenzo
- Division of Cardiology, AOU Città della Salute e della Scienza di Torino, Turin, Italy.
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40
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Wei JF, Wang S, Lu C. Umbilical artery flow monitoring with transesophageal echocardiography during maternal cardiac surgery. Int J Obstet Anesth 2019; 37:131-135. [PMID: 30274712 DOI: 10.1016/j.ijoa.2018.08.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2018] [Revised: 07/05/2018] [Accepted: 08/08/2018] [Indexed: 02/05/2023]
Affiliation(s)
- J F Wei
- Guangdong Cardiovascular Institute & Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangzhou, Guangdong Province, China; Shantou University Medical College, Shantou, Guangdong Province, China
| | - S Wang
- Guangdong Cardiovascular Institute & Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangzhou, Guangdong Province, China.
| | - C Lu
- Guangdong Cardiovascular Institute & Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangzhou, Guangdong Province, China
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41
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Yadav S, Pradhan M, Singh N, Majumdar G, Agarwal S. Combined cesarean section and mitral valve replacement in severe symptomatic mitral valve disease with unfavorable valve anatomy: Experience at a tertiary referral center of North India. HEART INDIA 2019. [DOI: 10.4103/heartindia.heartindia_24_19] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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42
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Gu J, Song H, Zhou W, Chen M. Transabdominal continuous echocardiographic monitoring of fetuses. Int J Obstet Anesth 2018; 39:146-148. [PMID: 30685300 DOI: 10.1016/j.ijoa.2018.12.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2018] [Accepted: 12/18/2018] [Indexed: 02/05/2023]
Affiliation(s)
- J Gu
- Department of Anesthesiology, West China Second Hospital, Sichuan University, Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu, Sichuan, PR China
| | - H Song
- Department of Anesthesiology, West China Hospital, Sichuan University, Chengdu, Sichuan, PR China.
| | - W Zhou
- Department of Anesthesiology, West China Hospital, Sichuan University, Chengdu, Sichuan, PR China
| | - M Chen
- Department of Anesthesiology, West China Hospital, Sichuan University, Chengdu, Sichuan, PR China
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43
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Tamura T, Yokota S. Mitral valve repair in infective endocarditis during pregnancy. Ann Card Anaesth 2018; 21:189-191. [PMID: 29652283 PMCID: PMC5914222 DOI: 10.4103/aca.aca_165_17] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Infective endocarditis (IE) during pregnancy and subsequent cardiac surgery are rare and associated with a high risk of mortality for the mother and fetus. It is difficult to determine the right time for cardiac intervention when IE is diagnosed early in pregnancy. A 33-year-old previously healthy woman in the 11th week of pregnancy was diagnosed with IE and underwent surgical intervention. The cardiopulmonary bypass settings and the anesthetic drugs were carefully chosen. Although she was in good health, while being discharged, the fetus did not survive. Anesthesiologists prioritizing the mother's survival should aim to improve fetal outcomes in such cases.
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Affiliation(s)
- Takahiro Tamura
- Department of Anesthesiology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Shuichi Yokota
- Division of Anesthesiology, ese Red Cross Nagoya Daiichi Hospital, Nagoya, Japan
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44
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Regitz-Zagrosek V, Roos-Hesselink JW, Bauersachs J, Blomström-Lundqvist C, Cífková R, De Bonis M, Iung B, Johnson MR, Kintscher U, Kranke P, Lang IM, Morais J, Pieper PG, Presbitero P, Price S, Rosano GMC, Seeland U, Simoncini T, Swan L, Warnes CA. 2018 ESC Guidelines for the management of cardiovascular diseases during pregnancy. Eur Heart J 2018; 39:3165-3241. [PMID: 30165544 DOI: 10.1093/eurheartj/ehy340] [Citation(s) in RCA: 1087] [Impact Index Per Article: 181.2] [Reference Citation Analysis] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
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45
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46
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Severe bicuspid aortic stenosis in pregnancy: balancing the risk of prematurity and maternal mortality. Cardiol Young 2018; 28:756-758. [PMID: 29415779 DOI: 10.1017/s104795111800001x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
We report a case of combined severe aortic stenosis and regurgitation in a pregnant patient with a history of congenital bicuspid aortic valve. The patient presented at 22 weeks of gestation with angina and pre-syncopal symptoms. During her admission, she experienced intermittent episodes of non-sustained ventricular tachycardia and hypotension. A multi-disciplinary healthcare team was assembled to decide on the appropriate medical and surgical treatment options. At 28 weeks of gestation, the patient underwent a caesarean delivery immediately followed by a mechanical aortic valve replacement.
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Jha N, Jha AK, Chand Chauhan R, Chauhan NS. Maternal and Fetal Outcome After Cardiac Operations During Pregnancy: A Meta-Analysis. Ann Thorac Surg 2018; 106:618-626. [PMID: 29660361 DOI: 10.1016/j.athoracsur.2018.03.020] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2017] [Revised: 03/06/2018] [Accepted: 03/06/2018] [Indexed: 01/11/2023]
Abstract
BACKGROUND In the past, cardiac surgical procedures during pregnancy have been associated with a high risk of adverse maternal and fetal outcomes. Therefore, this meta-analysis of more recent studies was done to assess the fetomaternal risk after cardiac operations during pregnancy using cardiopulmonary bypass. METHODS The MEDLINE, Embase, and Cochrane library were searched to find studies from January 1, 1990, to July 31, 2016, without language restriction. We selected studies that included at least 4 women to report fetomaternal outcomes after a cardiac operation using cardiopulmonary bypass during pregnancy. Two authors independently extracted data from the selected studies. The studies were assessed for methodological qualities using the Newcastle-Ottawa Scale. The primary outcomes included maternal death and any pregnancy loss. The secondary outcomes were maternal complications and neonatal complications. Primary analysis calculated absolute risks and 95% confidence intervals (CIs) for pregnancy outcomes using the DerSimonian-Laird random effects model. Heterogeneity was assessed by I2 statistic and visual plot. RESULTS Ten studies, including 154 women, were eligible for inclusion in this study. The patients underwent cardiac operations during pregnancy involving cardiopulmonary bypass. As calculated per 100 pregnancies, the pooled unadjusted estimate of maternal mortality was 11.2 (95% CI, 6.8 to 17.8), pregnancy loss was 33.1 (95% CI, 25.1 to 41.2), maternal complications were 8.8 (95% CI, 2.8 to 24.2), and neonatal complications were 10.8 (95% CI, 4.2 to 25.2). The risks of preterm labor and cesarean delivery were 28 per 100 pregnancies (95% CI, 15.6 to 45) and 33.8 per 100 pregnancies (95% CI, 19.1 to 52.4), respectively. CONCLUSIONS The fetomaternal mortality and morbidity after a cardiac operation during pregnancy are higher than that reported in the earlier literature (PROSPERO No. CRD42016047093).
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Affiliation(s)
- Nivedita Jha
- Department of Obstetrics and Gynecology, Pondicherry Institute of Medical Sciences, Puducherry, India
| | - Ajay Kumar Jha
- Department of Anesthesiology and Critical Care, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India.
| | - Ramesh Chand Chauhan
- Department of Community and Family Medicine, All India Institute of Medical Sciences, Bhubaneswar, India
| | - Neelima Singh Chauhan
- Department of Obstetrics and Gynecology, Pondicherry Institute of Medical Sciences, Puducherry, India
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48
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Boulemden A, Malin GL, Wallace SVF, Mahmoud A, Smith WHT, Szafranek AA. Mechanical Mitral Valve Replacement during the 2nd Trimester of Pregnancy. Tex Heart Inst J 2018; 45:31-34. [PMID: 29556149 DOI: 10.14503/thij-16-6144] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
We report the case of a 44-year-old pregnant woman who was diagnosed with symptomatic severe mitral stenosis that did not respond to optimal medical therapy and balloon valvuloplasty. After a multidisciplinary team discussion on the timing and risks of interventions and postoperative optimization of peripartum anticoagulation, the patient underwent mechanical mitral valve replacement during the 2nd trimester of pregnancy. The outcome was excellent for the mother and the infant. This case emphasizes the importance of a multidisciplinary approach in managing unusual cases.
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49
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Uehara K, Matsuda H, Matsuo J, Inoue Y, Omura A, Seike Y, Sasaki H, Kobayashi J. Acute type A aortic dissection repair in younger patients. J Card Surg 2018. [DOI: 10.1111/jocs.13558] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Affiliation(s)
- Kyokun Uehara
- Department of Cardiovascular Surgery; National Cerebral and Cardiovascular Center; Suita Osaka Japan
| | - Hitoshi Matsuda
- Department of Cardiovascular Surgery; National Cerebral and Cardiovascular Center; Suita Osaka Japan
| | - Jiro Matsuo
- Department of Cardiovascular Surgery; National Cerebral and Cardiovascular Center; Suita Osaka Japan
| | - Yosuke Inoue
- Department of Cardiovascular Surgery; National Cerebral and Cardiovascular Center; Suita Osaka Japan
| | - Atsushi Omura
- Department of Cardiovascular Surgery; National Cerebral and Cardiovascular Center; Suita Osaka Japan
| | - Yoshimasa Seike
- Department of Cardiovascular Surgery; National Cerebral and Cardiovascular Center; Suita Osaka Japan
| | - Hiroaki Sasaki
- Department of Cardiovascular Surgery; National Cerebral and Cardiovascular Center; Suita Osaka Japan
| | - Junjiro Kobayashi
- Department of Cardiovascular Surgery; National Cerebral and Cardiovascular Center; Suita Osaka Japan
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50
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Abstract
OBJECTIVE Cardiovascular disease is the major cause of pregnancy-related maternal mortality in the United States, and congenital heart disease (CHD) is the most common form of structural heart disease affecting women of childbearing age. Most females born with CHD will reach childbearing age and consider pregnancy. Adult CHD and maternal-fetal medicine (MFM) specialists managing women with CHD should provide preconception counseling, cardiovascular risk assessment prior to pregnancy that estimates maternal and fetal risk, management during pregnancy, and in the peripartum period and also know the potential complications and special circumstances that may occur in the post-partum period. This chapter will review the population at risk, patient risk prior to pregnancy, management during pregnancy, management in the peripartum and post-partum periods, and outline specific cardiovascular complications. The chapter will also briefly review some common or high-risk congenital cardiovascular lesions commonly encountered. CONCLUSION Management of patients with most forms of CHD encountered during pregnancy requires a multidisciplinary approach and careful team-based care to facilitate safe and appropriate management and pregnancy success.
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Affiliation(s)
- Heidi M Connolly
- Department of Cardiovascular Medicine, Mayo Clinic, 200 First St, SW, Rochester, MN 55905.
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