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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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Muacevic A, Adler JR, Tayade S, Tayade H. Anesthetic Management in Peripartum Cardiomyopathy: A Contemporary Review. Cureus 2022; 14:e33159. [PMID: 36726888 PMCID: PMC9885382 DOI: 10.7759/cureus.33159] [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] [Accepted: 12/30/2022] [Indexed: 01/01/2023] Open
Abstract
Peripartum cardiomyopathy (PPCM) is an uncommon disorder of the cardiovascular system and is linked to high rates of morbidity and mortality. It is an idiopathic condition characterized by left ventricular systolic dysfunction with an ejection fraction of approximately 45% near the end of pregnancy or immediately after delivery. Anesthesia management in these women is challenging due to low physiological reserve and potential negative effects on the fetus. To ensure that mother and child are supported safely through delivery, careful anesthesia control is required. Here, in this review article, we discuss the anesthetic implications in preoperative, operative, and postoperative phases in women with perioperative cardiomyopathy undergoing vaginal delivery or cesarean section.
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Moolla M, Mathew A, John K, Yogasundaram H, Alhumaid W, Campbell S, Windram J. Outcomes of pregnancy in women with hypertrophic cardiomyopathy: A systematic review. Int J Cardiol 2022; 359:54-60. [DOI: 10.1016/j.ijcard.2022.04.034] [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: 01/02/2022] [Revised: 03/08/2022] [Accepted: 04/11/2022] [Indexed: 11/05/2022]
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Dodeja AK, Siegel F, Dodd K, Ma'ayeh M, Mehta LS, Fuchs MM, Rood KM, Mah ML, Bradley EA. Heart failure in pregnancy: what is the long-term impact of pregnancy on cardiac function? A tertiary care centre experience and systematic review. Open Heart 2021; 8:openhrt-2021-001587. [PMID: 34344721 PMCID: PMC8336161 DOI: 10.1136/openhrt-2021-001587] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2021] [Accepted: 07/15/2021] [Indexed: 11/04/2022] Open
Abstract
Background Women with cardiomyopathy (CM) are often advised against pregnancy due to risk for major adverse cardiovascular events (MACE). However, the impact of CM subtype on maternal MACE is not understood, and so we sought to evaluate the influence of CM phenotype on maternal outcomes, as well as the effect on immediate and late left ventricular function. Methods We evaluated all pregnant women in our high-risk maternal cardiovascular programme (2009–2019). Composite maternal MACE included: death, inotrope use, left ventricular assist device, orthotopic heart transplant and/or escalation in transplant listing status, acute decompensated heart failure and sustained ventricular arrhythmia. Results Among 875 women followed, 32 had CM (29±7 years old, left ventricular ejection fraction (LVEF) 41%±12%): 3 ischaemic CM (ICM), 10 peripartum CM (PPCM) and 19 non-ICM (NICM). MACE events occurred in 6 (18%) women (PPCM: 2 (33%), NICM: 4 (67%)). There was no difference in LVEF at baseline, however, women with MACE had significantly lower LVEF both early (LVEF: 27±5% vs. 41±2%, p<0.05) and late post partum (LVEF: 28±5% vs. 44±2%, p<0.01). Conclusions In this contemporary cohort of women with CM, maternal MACE rates were lower than previously reported, and were less common in PPCM as compared with ICM and NICM. Heart function in women with MACE was negatively impacted immediately after delivery and in late postpartum follow-up, suggesting that pregnancy itself likely has influence on future left ventricular function in women with underlying CM.
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Affiliation(s)
- Anudeep K Dodeja
- Division of Cardiology, Nationwide Children's Hospital, Columbus, Ohio, USA .,Department of Internal Medicine, Division of Cardiovascular Medicine, The Ohio State University, Columbus, Ohio, USA
| | - Francesca Siegel
- The Ohio State University College of Medicine, Columbus, Ohio, USA
| | - Katherine Dodd
- Department of Internal Medicine, Division of Cardiovascular Medicine, The Ohio State University, Columbus, Ohio, USA
| | - Marwan Ma'ayeh
- Department of Obstetrics & Gynecology, Division of Maternal Fetal Medicine, The Ohio State University, Columbus, OH, USA
| | - Laxmi S Mehta
- Department of Internal Medicine, Division of Cardiovascular Medicine, The Ohio State University, Columbus, Ohio, USA
| | - Margaret M Fuchs
- Mayo Clinic Division of Cardiovascular Diseases, Rochester, Minnesota, USA
| | - Kara M Rood
- Department of Obstetrics & Gynecology, Division of Maternal Fetal Medicine, The Ohio State University, Columbus, OH, USA
| | - May Ling Mah
- Division of Cardiology, Nationwide Children's Hospital, Columbus, Ohio, USA
| | - Elisa A Bradley
- Department of Internal Medicine, Division of Cardiovascular Medicine, The Ohio State University, Columbus, Ohio, USA
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Abstract
Cardiomyopathy is a group of disorders in which the heart muscle is structurally and functionally abnormal in the absence of other diseases that could cause observed myocardial abnormality. The most common cardiomyopathies are hypertrophic and dilated cardiomyopathy. Rare types are arrhythmogenic right ventricular, restrictive, Takotsubo and left ventricular non-compaction cardiomyopathies. This review of cardiomyopathies in pregnancy shows that peripartum cardiomyopathy is the most common cardiomyopathy in pregnancy. Peripartum cardiomyopathy develops most frequently in the month before or after partum, whereas dilated cardiomyopathy often is known already or develops in the second trimester. Mortality in peripartum cardiomyopathy varies from <2% to 50%. Few reports on dilated cardiomyopathy and pregnancy exist, with only a limited number of patients. Ventricular arrhythmias, heart failure, stroke and death are found in 39%-60% of high-risk patients. However, patients with modest left ventricular dysfunction and good functional class tolerated pregnancy well. Previous studies on >700 pregnancies in 500 women with hypertrophic cardiomyopathy showed that prognosis was generally good, even though three deaths were reported in high-risk patients. Complications include different types of supraventricular and ventricular arrhythmias, heart failure and ischaemic stroke. Recent studies on 200 pregnancies in 100 women with arrhythmogenic right ventricular cardiomyopathy have reported symptoms, including heart failure in 18%-33% of pregnancies. Ventricular tachycardia was found in 0%-33% of patients and syncope in one patient. Information on rare cardiomyopathies is sparse and only presented in case reports. Close monitoring by multidisciplinary teams in referral centres that counsel patients before conception and follow them throughout gestation is recommended.
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Sivakumar RK, Panneerselvam S, Das S, Rudingwa P. Labour epidural analgesia in Hypertrophic Obstructive Cardiomyopathy. Indian J Anaesth 2019; 63:321-323. [PMID: 31000902 PMCID: PMC6460972 DOI: 10.4103/ija.ija_775_18] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Affiliation(s)
- Ranjith K Sivakumar
- Department of Anaesthesiology, Jawaharlal Institute of Postgraduate Medical Education and Research, Pondicherry, India
| | - Sakthirajan Panneerselvam
- Department of Anaesthesiology, Jawaharlal Institute of Postgraduate Medical Education and Research, Pondicherry, India
| | - Subashree Das
- Department of Anaesthesiology, Jawaharlal Institute of Postgraduate Medical Education and Research, Pondicherry, India
| | - Priya Rudingwa
- Department of Anaesthesiology, Jawaharlal Institute of Postgraduate Medical Education and Research, Pondicherry, India
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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: 1100] [Impact Index Per Article: 183.3] [Reference Citation Analysis] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
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Jumaah S, Çelekli A, Sucu M. The role of human urotensin-II in patients with hypertrophic cardiomyopathy. J Immunoassay Immunochem 2018; 39:150-162. [PMID: 28686108 DOI: 10.1080/15321819.2017.1344130] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
OBJECTIVE Hypertrophic cardiomyopathy (HCM) is a genetic condition with the hallmark feature of left ventricular hypertrophy. Human Urotensin-II (hUT-II) is regarded as a cardiovascular autacoid/hormone, and it has cardiac inotropic and hypertrophic properties. Aims of this study were to elucidate the clinical significance of serum hUT-II levels as a potential new biomarker in patients with HCM. METHODS This study included 40 HCM patients (60% males and 40% females) and were compared to 30 healthy control subjects (47% males and 53% females. All patients underwent extensive clinical, laboratory, and echocardiographic. Blood samples were taken to test for serum hUT-II levels by commercial ELISA Kit. RESULTS Serum hUT-II was significantly higher (p < 0.01) in patients with HCM (15.8 ± 2.1 pmol/L) compared with healthy controls (3.3 ± 1.7 pmol/L). With regard to HCM patient, Serum hUT-II levels were significantly higher in the female with 16.3 ± 1.9 pmol/L than the male with 15.4 ± 2.2 pmol/L (p < 0.05). Among echocardiographic parameters, hUT-II was negatively associated with ejection fraction (r = -0.160, p = 0.324). CONCLUSION Results of the first study indicated that serum hUT-II levels were markedly elevated in patients with HCM. Serum hUT-II is a novel biomarker parameter that has clinical use in patients with the severity of LVH.
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Affiliation(s)
- Saman Jumaah
- a Institute of Natural and Applied Sciences, Department of Biochemistry Science and Technology , Gaziantep University , Gaziantep , Turkey
| | - Abuzer Çelekli
- b Faculty of Arts and Science, Department of Biology , Gaziantep University , Gaziantep , Turkey
| | - Murat Sucu
- c Medical Faculty Cardiology , Gaziantep University , Gaziantep , Turkey
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