1
|
Comunale G, Susin FM, Mynard JP. Ventricular wall stress and wall shear stress homeostasis predicts cardiac remodeling during pregnancy: A modeling study. INTERNATIONAL JOURNAL FOR NUMERICAL METHODS IN BIOMEDICAL ENGINEERING 2022; 38:e3536. [PMID: 34599558 PMCID: PMC9285413 DOI: 10.1002/cnm.3536] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/03/2021] [Accepted: 09/29/2021] [Indexed: 06/13/2023]
Abstract
Pregnancy is a unique and dynamic process characterized by significant changes in the maternal cardiovascular system that are required to satisfy the increased maternal and fetal metabolic demands. Profound structural and hemodynamic adaptations occur during healthy pregnancy that allows the mother to maintain healthy hemodynamics and provide an adequate uteroplacental blood circulation to ensure physiological fetal development. Investigating these adaptations is crucial for understanding the physiology of pregnancy and may provide important insights for the management of high-risk pregnancies. However, no previous modeling studies have investigated the maternal cardiac structural changes that occur during gestation. This study, therefore, had two aims. The first was to develop a lumped parameter model of the whole maternal circulation that is suitable for studying global hemodynamics and cardiac function at different stages of gestation. The second was to test the hypothesis that myofiber stress and wall shear stress homeostasis principles can be used to predict cardiac remodeling that occurs during normal pregnancy. Hemodynamics and cardiac variables predicted from simulations with and without controlled cardiac remodeling algorithms were compared and evaluated with reference clinical data. While both models reproduced the hemodynamic variations that arise in pregnancy, importantly, we show that the structural changes that occur with pregnancy could be predicted by assuming invariant homeostatic "target" values of myocardial wall stress and chamber wall shear stress.
Collapse
Affiliation(s)
- Giulia Comunale
- Cardiovascular Fluid Dynamics Laboratory HER, Department of Civil, Environmental and Architectural EngineeringUniversity of PadovaPadovaItaly
- Heart ResearchMurdoch Children's Research InstituteParkvilleVictoriaAustralia
| | - Francesca M. Susin
- Cardiovascular Fluid Dynamics Laboratory HER, Department of Civil, Environmental and Architectural EngineeringUniversity of PadovaPadovaItaly
| | - Jonathan P. Mynard
- Heart ResearchMurdoch Children's Research InstituteParkvilleVictoriaAustralia
- Department of PediatricsUniversity of MelbourneParkvilleVictoriaAustralia
- Department of Biomedical EngineeringUniversity of MelbourneParkvilleVictoriaAustralia
| |
Collapse
|
2
|
Vogel B, Acevedo M, Appelman Y, Bairey Merz CN, Chieffo A, Figtree GA, Guerrero M, Kunadian V, Lam CSP, Maas AHEM, Mihailidou AS, Olszanecka A, Poole JE, Saldarriaga C, Saw J, Zühlke L, Mehran R. The Lancet women and cardiovascular disease Commission: reducing the global burden by 2030. Lancet 2021; 397:2385-2438. [PMID: 34010613 DOI: 10.1016/s0140-6736(21)00684-x] [Citation(s) in RCA: 507] [Impact Index Per Article: 169.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2020] [Revised: 03/08/2021] [Accepted: 03/12/2021] [Indexed: 02/07/2023]
Abstract
Cardiovascular disease is the leading cause of death in women. Decades of grassroots campaigns have helped to raise awareness about the impact of cardiovascular disease in women, and positive changes affecting women and their health have gained momentum. Despite these efforts, there has been stagnation in the overall reduction of cardiovascular disease burden for women in the past decade. Cardiovascular disease in women remains understudied, under-recognised, underdiagnosed, and undertreated. This Commission summarises existing evidence and identifies knowledge gaps in research, prevention, treatment, and access to care for women. Recommendations from an international team of experts and leaders in the field have been generated with a clear focus to reduce the global burden of cardiovascular disease in women by 2030. This Commission represents the first effort of its kind to connect stakeholders, to ignite global awareness of sex-related and gender-related disparities in cardiovascular disease, and to provide a springboard for future research.
Collapse
Affiliation(s)
- Birgit Vogel
- Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Monica Acevedo
- Divisón de Enfermedades Cardiovasculares, Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Yolande Appelman
- Amsterdam UMC, VU University Medical Center, Amsterdam, Netherlands
| | - C Noel Bairey Merz
- Barbra Streisand Women's Heart Center, Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Alaide Chieffo
- Interventional Cardiology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Gemma A Figtree
- Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
| | - Mayra Guerrero
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, USA
| | - Vijay Kunadian
- Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Newcastle Upon Tyne, UK; Cardiothoracic Centre, Freeman Hospital, Newcastle upon Tyne Hospitals NHS Foundations Trust, Newcastle Upon Tyne, UK
| | - Carolyn S P Lam
- National Heart Centre Singapore, Singapore; Cardiovascular Sciences Academic Clinical Programme, Duke-National University of Singapore, Singapore
| | - Angela H E M Maas
- Department of Women's Cardiac Health, Radboud University Medical Center, Nijmegen, Netherlands
| | - Anastasia S Mihailidou
- Royal North Shore Hospital, Northern Sydney Local Health District, Sydney, NSW, Australia; Cardiovascular and Hormonal Research Laboratory, Kolling Institute, Sydney, NSW, Australia; Faculty of Medicine and Health Sciences, Macquarie University, Sydney, NSW, Australia
| | - Agnieszka Olszanecka
- 1st Department of Cardiology, Interventional Electrocardiology and Hypertension, Faculty of Medicine, Jagiellonian University Medical College, Krakow, Poland
| | - Jeanne E Poole
- Division of Cardiology, University of Washington Medical Center, Seattle, WA, USA
| | - Clara Saldarriaga
- Department of Cardiology and Heart Failure Clinic, Clinica CardioVID, University of Antioquia, Medellín, Colombia
| | - Jacqueline Saw
- Division of Cardiology, Vancouver General Hospital, Vancouver, BC, Canada
| | - Liesl Zühlke
- Departments of Paediatrics and Medicine, Divisions of Paediatric and Adult Cardiology, Red Cross Children's and Groote Schuur Hospital, University of Cape Town, Cape Town, South Africa
| | - Roxana Mehran
- Icahn School of Medicine at Mount Sinai, New York, NY, USA.
| |
Collapse
|
3
|
|
4
|
Detzner AA, Hopkins KA, Kay WA, Hoyer MH. Successful TPV Implantation in a Pregnant Patient With Right Ventricle to Pulmonary Artery Conduit Obstruction. JACC Case Rep 2020; 2:135-138. [PMID: 34316981 PMCID: PMC8301511 DOI: 10.1016/j.jaccas.2019.11.055] [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: 09/06/2019] [Revised: 11/25/2019] [Accepted: 11/25/2019] [Indexed: 12/04/2022]
Abstract
A patient with repaired double outlet right ventricle presented during early gestation with heart failure symptoms due to severe right ventricle–pulmonary artery conduit stenosis and insufficiency. In the first trimester, she underwent transcatheter therapy with Melody pulmonary valve implantation with excellent hemodynamic results and completed pregnancy without significant maternal complications. (Level of Difficulty: Advanced.)
Collapse
|
5
|
Lima NDA, Santos GS, Lima CCDV, Schauer MD. Percutaneous mitral balloon valvulotomy in pregnant women with mitral stenosis from rheumatic heart disease: a series of cases. J OBSTET GYNAECOL 2019; 40:1169-1170. [DOI: 10.1080/01443615.2019.1693525] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Affiliation(s)
- Neiberg de Alcantara Lima
- Department of Internal Medicine, Western Michigan University Homer Stryker MD School of Medicine, Kalamazoo, MI, USA
- Department of Internal Medicine/Cardiology, Hospital Universitario Walter Cantidio, Universidade Federal do Ceara, Fortaleza, Brazil
| | - Glaylton Silva Santos
- Department of Internal Medicine/Cardiology, Hospital Universitario Walter Cantidio, Universidade Federal do Ceara, Fortaleza, Brazil
| | | | - Mark D Schauer
- Department of Internal Medicine, Western Michigan University Homer Stryker MD School of Medicine, Kalamazoo, MI, USA
| |
Collapse
|
6
|
O'Kelly AC, Sharma G, Vaught AJ, Zakaria S. The Use of Echocardiography and Advanced Cardiac Ultrasonography During Pregnancy. CURRENT TREATMENT OPTIONS IN CARDIOVASCULAR MEDICINE 2019; 21:71. [PMID: 31754837 PMCID: PMC8015779 DOI: 10.1007/s11936-019-0785-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
PURPOSE OF REVIEW Pregnancy is a time of significant cardiovascular change. Echocardiography is the primary imaging modality used to assess cardiovascular anatomy and physiology during pregnancy. Both two-dimensional (2D) echocardiography and advanced cardiac ultrasound modalities play pivotal roles in identifying and monitoring these changes, especially in women with preexisting or new cardiac disease. This paper reviews the role of echocardiography and advanced cardiac ultrasound during normal pregnancy and pregnancy complicated by hypertensive disorders, valvular disorders, and cardiomyopathy. It also examines the role of echocardiography in guiding decisions about delivery. RECENT FINDINGS The data establishing normal echo parameters during pregnancy are inconsistent. In addition, there is limited research exploring the role of advanced cardiac ultrasound modalities, such as tissue Doppler imaging or speckle tracking echocardiography, in assessing cardiac function during pregnancy. What data there are suggest that these advanced modalities can be used to identify subclinical changes before traditional echocardiography can, and thus have clear utility in identifying early abnormal cardiac responses to pregnancy. Echocardiography is the modality of choice for imaging the heart in pregnant women. Advanced ultrasound modalities increasingly play a role in identifying abnormal adaptations to pregnancy and detecting subclinical changes. This, in turn, can help promote a healthy pregnancy for both mother and fetus.
Collapse
Affiliation(s)
- Anna C O'Kelly
- Department of Medicine, Massachusetts General Hospital, 55 Fruit St, Boston, MA, 02114, USA.
| | - Garima Sharma
- Department of Medicine, Johns Hopkins University School of Medicine, 4940 Eastern Ave. Bldg 301, Suite 2400, Baltimore, MD, 21224, USA
| | - Arthur Jason Vaught
- Department of Gynecology and Obstetrics, Johns Hopkins University School of Medicine, 660 North Wolfe Street, Phipps 228, Baltimore, MD, 21287, USA
| | - Sammy Zakaria
- Department of Medicine, Johns Hopkins University School of Medicine, 4940 Eastern Ave. Bldg 301, Suite 2400, Baltimore, MD, 21224, USA
| |
Collapse
|
7
|
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
| |
Collapse
|
8
|
Brun S, L'Ecuyer E, Dore A, Mongeon FP, Guedon AC, Leduc L. Impact of maternal pulmonary insufficiency on fetal growth in pregnancy. J Matern Fetal Neonatal Med 2018; 33:1100-1106. [PMID: 30130989 DOI: 10.1080/14767058.2018.1514492] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
Rationale: It is known that fetal growth is usually proportional to left-sided cardiac output (CO), which parallels the right-sided CO and that congenital right-sided lesions are usually associated with better perinatal outcomes than left-sided lesions.Objective: Our objective was to document whether newborns from mothers with severe residual pulmonary valve insufficiency (PI) after surgical tetralogy of Fallot (TOF) or pulmonary valve stenosis (PS) correction have lower birth weight (BW) than newborns from mothers with absent, mild, or moderate PI.Methods: This is a retrospective cohort study of women affected with repaired TOF and corrected PS with varied severity of residual PI. Exclusion criteria were: left ventricular dysfunction, left-sided valvular heart disease, other right-sided structural heart disease, chronic hypertension, substance addiction, and incomplete follow-up. Pregnancies were divided into three groups: absent or mild PI, moderate PI, and severe PI. A generalized linear model with normal dependent variable distribution was built and the parameter estimation made with Generalized Estimation Equations (GEE) to take into account repeated mother in data. Variables such as gestational age at birth, maternal age, smoking, and body mass index were tested with bivariate analyses to assess their effect on BW. Only gestational age remained in the adjusted model.Results: A total of 45 patients were included (33 TOF and 12 PS) and 97 pregnancies were reported: 22 miscarriages (22.7%) (15 TOF, 7 PS) and 75 successful pregnancies (57 TOF, 18 PS). The patients were divided into three groups: 1) absent or mild PI, 2) moderate PI, and 3) severe PI groups, which comprised, respectively, 29 (15 TOF, 4 PS), 20 (10 TOF, 1 PS), and 26 successful pregnancies (8 TOF, 7 PS). Using three levels of PI (absent or mild, moderate, and severe), the unadjusted model showed a significant effect of level of PI on BW (p = .0118), as well as the adjusted model (p = .0263) with gestational age as a covariate. The estimated mean newborn's BW was 3055.8 g in the severe PI group, 3151.0 g in the moderate PI group, and 3376.4 g in the absent or mild group when adjusted for gestational age. Hence, we estimated that the mean newborn's BW is 321 g lower in the severe PI group compared with absent or mild PI group ((CI: 572.3; -68.9), p = .0087).Conclusions: Pregnancy is usually well tolerated in repaired TOF and corrected PS. Severe PI either from repaired TOF or PS is at higher risk of lower newborn's BW. Special attention must be paid to the severity of PI. Fetal growth surveillance in the third trimester is warranted.
Collapse
Affiliation(s)
- Stephanie Brun
- Maternal-Fetal Medicine Division, Obstetrics & Gynecology Department, Sainte-Justine University Hospital, Montreal, Canada.,Maternité Centre Aliénor d'Aquitaine, CHU Bordeaux, Bordeaux, France
| | - Emilie L'Ecuyer
- Research Centre, Sainte-Justine University Hospital, Montreal, Canada.,Université de Montréal, Montreal, Qc, Canada
| | - Annie Dore
- Université de Montréal, Montreal, Qc, Canada.,Adult Congenital Heart Disease Centre, Department of Medicine, Montreal Heart Institute, Montreal, Qc, Canada
| | - François-Pierre Mongeon
- Université de Montréal, Montreal, Qc, Canada.,Adult Congenital Heart Disease Centre, Department of Medicine, Montreal Heart Institute, Montreal, Qc, Canada
| | - Aude-Christine Guedon
- Université de Montréal, Montreal, Qc, Canada.,Applied Clinical Research Unit (ACRU), Montreal, Qc, Canada
| | - Line Leduc
- Maternal-Fetal Medicine Division, Obstetrics & Gynecology Department, Sainte-Justine University Hospital, Montreal, Canada.,Research Centre, Sainte-Justine University Hospital, Montreal, Canada.,Université de Montréal, Montreal, Qc, Canada
| |
Collapse
|
9
|
Akutsu H, Kaminishi Y, Kurumisawa S, Misawa Y. Bioprosthetic aortic valve replacement 12 years after percutaneous aortic valvuloplasty in a young female adult with hope of pregnancy. Acute Med Surg 2017; 3:364-368. [PMID: 28163921 PMCID: PMC5256424 DOI: 10.1002/ams2.178] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2015] [Accepted: 10/26/2015] [Indexed: 11/10/2022] Open
Abstract
CASE A 26-year-old woman who had congenital aortic valve stenosis presented with exertional dyspnea. She had undergone percutaneous balloon aortic valvuloplasty 12 years previously at the age of 14. When she was 20 years old, she delivered a neonate by elective cesarean section at the 31st week of gestation because the mean pressure between the left ventricle and the ascending aorta was 52 mmHg. OUTCOME She successfully underwent aortic valve replacement with a bioprosthetic valve combined with replacement of the ascending aorta in order to make the next pregnancy possible. CONCLUSION The long-term prognosis of percutaneous balloon aortic valvuloplasty might be acceptable for some patients, even though this procedure is associated with the possibility of secondary interventions.
Collapse
Affiliation(s)
- Hirohiko Akutsu
- Division of Cardiovascular Surgery Jichi Medical University Shimotsuke Tochigi Japan
| | - Yuichiro Kaminishi
- Division of Cardiovascular Surgery Jichi Medical University Shimotsuke Tochigi Japan
| | - Soki Kurumisawa
- Division of Cardiovascular Surgery Jichi Medical University Shimotsuke Tochigi Japan
| | - Yoshio Misawa
- Division of Cardiovascular Surgery Jichi Medical University Shimotsuke Tochigi Japan
| |
Collapse
|
10
|
|
11
|
Wu W, Chen Q, Zhang L, Chen W. Epidural anesthesia for cesarean section for pregnant women with rheumatic heart disease and mitral stenosis. Arch Gynecol Obstet 2016; 294:103-8. [DOI: 10.1007/s00404-015-4003-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2015] [Accepted: 12/21/2015] [Indexed: 10/22/2022]
|