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Singh T, Mishra AK, Vojjala N, John KJ, George AA, Jha A, Hadley M. Cardiovascular complications following medical termination of pregnancy: An updated review. World J Cardiol 2023; 15:518-530. [PMID: 37900907 PMCID: PMC10600792 DOI: 10.4330/wjc.v15.i10.518] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Revised: 08/22/2023] [Accepted: 09/18/2023] [Indexed: 10/24/2023] Open
Abstract
BACKGROUND Around 1 million cases of medical termination of pregnancy (MTP) take place yearly in the United States of America with around 2 percent of this population developing complications. The cardiovascular (CVD) complications occurring post MTP or after stillbirth is not very well described. AIM To help the reader better understand, prepare, and manage these complications by reviewing various cardiac comorbidities seen after MTP. METHODS We performed a literature search in PubMed, Medline, RCA, and google scholar, using the search terms "abortions" or "medical/legal termination of pregnancy" and "cardiac complications" or "cardiovascular complications". RESULTS The most common complications described in the literature following MTP were infective endocarditis (IE) (n = 16), takotsubo cardiomyopathy (TTC) (n = 7), arrhythmias (n = 5), and sudden coronary artery dissection (SCAD) (n = 4). The most common valve involved in IE was the tricuspid valve in 69% (n = 10). The most observed causative organism was group B Streptococcus in 81% (n = 12). The most common type of TTC was apical type in 57% (n = 4). Out of five patients developing arrhythmia, bradycardia was the most common and was seen in 60% (3/5) of the patients. All four cases of SCAD-P type presented as acute coronary syndrome 10-14 d post termination of pregnancy with predominant involvement of the right coronary artery. Mortality was only reported following IE in 6.25%. Clinical recovery was reported consistently after optimal medical management following all these complications. CONCLUSION In conclusion, the occurrence of CVD complications following pregnancy termination is infrequently documented in the existing literature. In this review, the most common CVD complication following MTP was noted to be IE and TTC.
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Affiliation(s)
- Tejveer Singh
- Department of Internal Medicine, Saint Vincent Hospital, Worcester, MA 01608, United States
| | - Ajay K Mishra
- Division of Cardiology, Saint Vincent Hospital, Worcester, MA 01608, United States.
| | - Nikhil Vojjala
- Department of Internal Medicine, Post-Graduation Institute of Medical Education and Research, Chandigarh 00000, India
| | - Kevin John John
- Department of Internal Medicine, Tufts Medical Center, Boston, MA 01212, United States
| | - Anu A George
- Department of Internal Medicine, Saint Vincent Hospital, Worcester, MA 01608, United States
| | - Anil Jha
- Division of Cardiology, Saint Vincent Hospital, Worcester, MA 01608, United States
| | - Michelle Hadley
- Division of Cardiology, Saint Vincent Hospital, Worcester, MA 01608, United States
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Monari C, Molinari D, Cornelli A, Alessio L, Coppolino F, Barbareschi C, De Pascalis S, Torella M, Cimmino G, De Feo M, Coppola N, Formisano T. An Unusual Case of a Double Tricuspid and Mitral Valves Infective Endocarditis Complicated by Multiple Septic Embolisms Secondary to an Atrial Septal Defect: A Case Report and Review of Literature. Infect Dis Rep 2023; 15:494-503. [PMID: 37736996 PMCID: PMC10514809 DOI: 10.3390/idr15050049] [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: 07/07/2023] [Revised: 08/25/2023] [Accepted: 08/28/2023] [Indexed: 09/23/2023] Open
Abstract
Multivalvular endocarditis (MVE) is an uncommon infection that mostly involves mitral and aortic valves, and it is related to a higher risk of congestive heart failure and a higher mortality. We described a case of a bilateral MVE and performed a review of the literature on similar clinical cases. We reported an unusual case of a 68-year-old male patient with a tricuspid and mitral infective endocarditis due to a methicillin-resistant Staphylococcus aureus complicated by multiple right- and left-sided septic embolization (lungs, brain, spleen, L2-L3 vertebral bones) due to an unknown atrial septal defect identified and repaired during cardiac surgery. Despite the severity of the clinical case, the patient experienced a good clinical outcome also thanks to a multidisciplinary approach. We identified 21 case reports describing bilateral MVE. A multidisciplinary approach is essential in the management of valve diseases to improve the prognosis of patients, especially in bilateral MVE.
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Affiliation(s)
- Caterina Monari
- Infectious Diseases Unit, Department of Mental Health and Public Medicine, Section of Infectious Diseases, University of Campania Luigi Vanvitelli, Via L. Armanni 5, 80131 Naples, Italy; (C.M.); (A.C.); (L.A.); (S.D.P.)
| | - Daniele Molinari
- Cardiology Unit, Azienda Ospedaliera Universitaria Luigi Vanvitelli, Piazza Miraglia 2, 80138 Naples, Italy; (D.M.); (C.B.); (G.C.); (T.F.)
| | - Alessandro Cornelli
- Infectious Diseases Unit, Department of Mental Health and Public Medicine, Section of Infectious Diseases, University of Campania Luigi Vanvitelli, Via L. Armanni 5, 80131 Naples, Italy; (C.M.); (A.C.); (L.A.); (S.D.P.)
| | - Loredana Alessio
- Infectious Diseases Unit, Department of Mental Health and Public Medicine, Section of Infectious Diseases, University of Campania Luigi Vanvitelli, Via L. Armanni 5, 80131 Naples, Italy; (C.M.); (A.C.); (L.A.); (S.D.P.)
| | - Francesco Coppolino
- Department of Women, Child and General and Specialized Surgery, Section of Anaesthesiology, University of Campania Luigi Vanvitelli, Piazza Miraglia 2, 80138 Naples, Italy;
| | - Consiglia Barbareschi
- Cardiology Unit, Azienda Ospedaliera Universitaria Luigi Vanvitelli, Piazza Miraglia 2, 80138 Naples, Italy; (D.M.); (C.B.); (G.C.); (T.F.)
| | - Stefania De Pascalis
- Infectious Diseases Unit, Department of Mental Health and Public Medicine, Section of Infectious Diseases, University of Campania Luigi Vanvitelli, Via L. Armanni 5, 80131 Naples, Italy; (C.M.); (A.C.); (L.A.); (S.D.P.)
| | - Michele Torella
- Department of Translational Medical Sciences, Section of Cardiac Surgery and Heart Transplant, University of Campania Luigi Vanvitelli, via L. Bianchi c/o Ospedale Monaldi, 80131 Naples, Italy; (M.T.); (M.D.F.)
| | - Giovanni Cimmino
- Cardiology Unit, Azienda Ospedaliera Universitaria Luigi Vanvitelli, Piazza Miraglia 2, 80138 Naples, Italy; (D.M.); (C.B.); (G.C.); (T.F.)
- Department of Translational Medical Sciences, Section of Cardiology, University of Campania Luigi Vanvitelli, via L. Bianchi c/o Ospedale Monaldi, 80131 Naples, Italy
| | - Marisa De Feo
- Department of Translational Medical Sciences, Section of Cardiac Surgery and Heart Transplant, University of Campania Luigi Vanvitelli, via L. Bianchi c/o Ospedale Monaldi, 80131 Naples, Italy; (M.T.); (M.D.F.)
| | - Nicola Coppola
- Infectious Diseases Unit, Department of Mental Health and Public Medicine, Section of Infectious Diseases, University of Campania Luigi Vanvitelli, Via L. Armanni 5, 80131 Naples, Italy; (C.M.); (A.C.); (L.A.); (S.D.P.)
| | - Tiziana Formisano
- Cardiology Unit, Azienda Ospedaliera Universitaria Luigi Vanvitelli, Piazza Miraglia 2, 80138 Naples, Italy; (D.M.); (C.B.); (G.C.); (T.F.)
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Kebed KY, Bishu K, Al Adham RI, Baddour LM, Connolly HM, Sohail MR, Steckelberg JM, Wilson WR, Murad MH, Anavekar NS. Pregnancy and postpartum infective endocarditis: a systematic review. Mayo Clin Proc 2014; 89:1143-52. [PMID: 24997091 DOI: 10.1016/j.mayocp.2014.04.024] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/01/2014] [Revised: 03/31/2014] [Accepted: 04/04/2014] [Indexed: 10/25/2022]
Abstract
The objective of this review was to describe the clinical characteristics, risk factors, and outcomes of infective endocarditis (IE) in pregnancy and the postpartum period. We conducted a systematic review of Ovid MEDLINE, Ovid Embase, Web of Science, and Scopus from January 1, 1988, through October 31, 2012. Included studies reported on women who met the modified Duke criteria for the diagnosis of IE and were pregnant or postpartum. We included 72 studies that described 90 cases of peripartum IE, mostly affecting native valves (92%). Risk factors associated with IE included intravenous drug use (14%), congenital heart disease (12%), and rheumatic heart disease (12%). The most common pathogens were streptococcal (43%) and staphylococcal (26%) species. Septic pulmonary, central, and other systemic emboli were common complications. Of the 51 pregnancies, there were 41 (80%) deliveries with survival to discharge, 7 (14%) fetal deaths, 1 (2%) medical termination of pregnancy, and 2 (4%) with unknown status. Maternal mortality was 11%. Infective endocarditis is a rare, life-threatening infection in pregnancy. Risk factors are changing with a marked decrease in rheumatic heart disease and an increase in intravenous drug use. The cases reported in the literature were commonly due to streptococcal organisms, involved the right-sided valves, and were associated with intravenous drug use.
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MESH Headings
- Adult
- Endocarditis, Bacterial/etiology
- Endocarditis, Bacterial/microbiology
- Endocarditis, Bacterial/mortality
- Female
- Heart Defects, Congenital/complications
- Heart Defects, Congenital/microbiology
- Humans
- Infant Mortality
- Infant, Newborn
- Maternal Mortality
- Peripartum Period
- Pregnancy
- Pregnancy Complications, Cardiovascular/etiology
- Pregnancy Complications, Cardiovascular/microbiology
- Pregnancy Complications, Cardiovascular/mortality
- Pregnancy Complications, Infectious/etiology
- Pregnancy Complications, Infectious/microbiology
- Pregnancy Complications, Infectious/mortality
- Pregnancy Outcome
- Rheumatic Heart Disease/complications
- Rheumatic Heart Disease/microbiology
- Risk Factors
- Substance Abuse, Intravenous/complications
- Substance Abuse, Intravenous/microbiology
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Affiliation(s)
- Kalie Y Kebed
- Department of Internal Medicine, Mayo Clinic, Rochester, MN.
| | - Kalkidan Bishu
- Department of Cardiovascular Diseases, Mayo Clinic, Rochester, MN
| | - Raed I Al Adham
- Department of Internal Medicine, St. Joseph's Hospital, Phoenix, AZ
| | - Larry M Baddour
- Department of Infectious Diseases, Mayo Clinic, Rochester, MN
| | - Heidi M Connolly
- Department of Cardiovascular Diseases, Mayo Clinic, Rochester, MN
| | | | | | - Walter R Wilson
- Department of Infectious Diseases, Mayo Clinic, Rochester, MN
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Karabulut A, Surgit O, Akgul O, Bakir I. "Removal without Replacement" Strategy for Uncontrolled Prosthetic Tricuspid Valve Endocarditis Associated with Abortion Sepsis. Heart Surg Forum 2011; 14:E357-9. [DOI: 10.1532/hsf98.20101174] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Isolated tricuspid valve (TV) endocarditis associated with abortion is a rare entity with a poor prognosis. We report the case of a 22-year-old woman with a diagnosis of isolated prosthetic TV endocarditis secondary to recurrent abortion. The patient had progressed to multiorgan failure and disseminated intravascular coagulation during her clinical course. Because of the high operative risk and uncontrolled infection, we performed an unusual surgical approach that has not previously been reported. Resection of infected valvular tissue without replacement of the prosthesis led to a rapid convalescence period and complete cure.
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