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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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Ayati A, Sarraf S, Asl Fallah S, Bagheri J, Ahmadi Tafti H, Same K, Hosseini K. Aortic dissection in the first trimester; is it a dead end? A narrative review of recent articles. J Card Surg 2022; 37:1705-1711. [PMID: 35352396 DOI: 10.1111/jocs.16451] [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: 12/29/2021] [Revised: 02/13/2022] [Accepted: 02/17/2022] [Indexed: 12/29/2022]
Abstract
INTRODUCTION Acute-type aortic dissection (AD) during pregnancy is considered a rare and potentially fatal complication for both mother and fetus. Although the definite treatment for an acute-type AD is considered to be open-heart surgery, the decision to perform such a surgery during pregnancy requires a multidisciplinary approach and carries significant risks. METHODS In the present review of the literature, we have discussed various challenges in the management of acute-type AD during pregnancy, including therapeutic approaches, choosing the preferred imaging modalities, surgical techniques, and medication challenges. We have also reported an 8-week pregnant woman with Marfan syndrome who presented with chest pain and was diagnosed with acute AD. RESULTS The patient underwent a Bentall operation and was discharged in good condition with her fetus alive. The medical team's various decisions during preoperative, operative, and postoperative treatments were discussed. CONCLUSIONS Type A AD is considered infrequent in the second and third trimester of pregnancy and rare in the first trimester. Performing a CMR study without contrast in stable patients can help evaluate the extension of the flap. Urgent surgery in the hands of a skilled surgeon may prove lifesaving for the mother while maximizing the likelihood of preserving the fetus.
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Affiliation(s)
- Aryan Ayati
- Tehran Heart Center, Tehran Heart Center Research Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Syna Sarraf
- Tehran Heart Center, Tehran Heart Center Research Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Sahar Asl Fallah
- Rajaie Cardiovascular Medical And Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Jamshid Bagheri
- Tehran Heart Center, Tehran Heart Center Research Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Hossein Ahmadi Tafti
- Tehran Heart Center, Tehran Heart Center Research Institute, Tehran University of Medical Sciences, Tehran, Iran.,Research Center for Advanced Technologies in Cardiovascular Medicine, Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Kaveh Same
- Tehran Heart Center, Tehran Heart Center Research Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Kaveh Hosseini
- Tehran Heart Center, Tehran Heart Center Research Institute, Tehran University of Medical Sciences, Tehran, Iran
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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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Cottrell J, Calhoun J, Szczepanski J, Corvera J, Creswell LL, Kogon B, Hasaniya N, Copeland H. Aortic root valve‐sparing repair and dissections in Marfans syndrome during pregnancy: A case series. J Card Surg 2020; 35:1439-1443. [DOI: 10.1111/jocs.14592] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Affiliation(s)
- Jesse Cottrell
- Department of Obstetrics and Gynecology Marshall University Huntington West Virginia
| | - John Calhoun
- Department of Surgery University of Mississippi Medical Center Jackson Mississippi
| | - Jamie Szczepanski
- Department of Obstetrics and Gynecology University of Mississippi Medical Center Jackson Mississippi
| | - Joel Corvera
- Department of Surgery Indiana University Health Indianapolis Indiana
| | - Lawrence L. Creswell
- Department of Surgery University of Mississippi Medical Center Jackson Mississippi
| | - Brian Kogon
- Department of Surgery University of Mississippi Medical Center Jackson Mississippi
| | - Nahidh Hasaniya
- Dignity Health Medical Group Inland Empire San Bernardino California
| | - Hannah Copeland
- Department of Surgery University of Mississippi Medical Center Jackson Mississippi
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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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Grewal J, Silversides CK, Colman JM. Pregnancy in women with heart disease: risk assessment and management of heart failure. Heart Fail Clin 2014; 10:117-29. [PMID: 24275299 DOI: 10.1016/j.hfc.2013.09.014] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Heart disease, present in 0.5% to 3% of pregnant women, is an important cause of morbidity and the leading cause of death among pregnant women in the developed world. Certain heart conditions are associated with an increased risk of heart failure during pregnancy or the postpartum period; for these conditions, management during pregnancy benefits from multidisciplinary care at a center with expertise in pregnancy and heart disease. This article focuses on cardiac risks and management strategies for women with acquired and congenital heart disease who are at increased risk of heart failure during pregnancy.
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Affiliation(s)
- Jasmine Grewal
- University of British Columbia Cardiac Obstetrics Clinic and Pacific Adult Congenital Heart Clinic, Division of Cardiology, St. Paul's Hospital, University of British Columbia, Room 344-1081, Burrard Street, Vancouver, British Columbia V6Z 1Y6, Canada.
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Abstract
BACKGROUND Patient-prosthesis mismatch is a known and severe complication after aortic valve repair in the general population. There is a paucity of literature regarding this condition in pregnancy. CASE We present the clinical course of a pregnant woman with severe patient-prosthesis mismatch after aortic valve replacement. After extensive workup, the patient underwent aortic valve replacement, enlargement of the aortic root, and placement of a larger prosthetic valve at 21 weeks of gestation. Her postoperative course was complicated by fetal death. CONCLUSION Cardiopulmonary bypass and aortic valve replacement present a multitude of risks to maternal and fetal health. The obstetrician managing pregnant women with prosthetic heart valves should be aware of the complications that may arise, including patient-prosthesis mismatch.
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Yuan SM. Indications for Cardiopulmonary Bypass During Pregnancy and Impact on Fetal Outcomes. Geburtshilfe Frauenheilkd 2014; 74:55-62. [PMID: 24741119 DOI: 10.1055/s-0033-1350997] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2013] [Revised: 09/29/2013] [Accepted: 10/01/2013] [Indexed: 01/03/2023] Open
Abstract
Background: Cardiac operations in pregnant patients are a challenge for physicians in multidisciplinary teams due to the complexity of the condition which affects both mother and baby. Management strategies vary on a case-by-case basis. Feto-neonatal and maternal outcomes after cardiopulmonary bypass (CPB) in pregnancy, especially long-term follow-up results, have not been sufficiently described. Methods: This review was based on a complete literature retrieval of articles published between 1991 and April 30, 2013. Results: Indications for CPB during pregnancy were cardiac surgery in 150 (96.8 %) patients, most of which consisted of valve replacements for mitral and/or aortic valve disorders, resuscitation due to amniotic fluid embolism, autotransfusion, and circulatory support during cesarean section to improve patient survival in 5 (3.2 %) patients. During CPB, fetuses showed either a brief heart rate drop with natural recovery after surgery or, in most cases, fetal heart rate remained normal throughout the whole course of CPB. Overall feto-neonatal mortality was 18.6 %. In comparison with pregnant patients whose baby survived, feto-neonatal death occurred after a significantly shorter gestational period at the time of onset of cardiac symptoms, cardiac surgery/resuscitation under CPB in the whole patient setting, or cardiac surgery/resuscitation with CPB prior to delivery. Conclusions: The most common surgical indications for CPB during pregnancy were cardiac surgery, followed by resuscitation for cardiopulmonary collapse. CPB was used most frequently in maternal cardiac surgery/resuscitation in the second trimester. Improved CPB conditions including high flow, high pressure and normothermia or mild hypothermia during pregnancy have benefited maternal and feto-neonatal outcomes. A shorter gestational period and the use of CPB during pregnancy were closely associated with feto-neonatal mortality. It is therefore important to attempt delivery ahead of surgery/CPB or to defer surgery till late pregnancy.
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Affiliation(s)
- S-M Yuan
- Department of Cardiothoracic Surgery, The First Hospital of Putian, Teaching Hospital, Fujian Medical University, Putian, Fujian Province, China
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Rivero C, Cerizola M, Kohn E, Riva J. [Anaestheia for valve replacement in the second trimester of pregnancy]. REVISTA ESPANOLA DE ANESTESIOLOGIA Y REANIMACION 2014; 61:35-38. [PMID: 23228671 DOI: 10.1016/j.redar.2012.10.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/22/2012] [Revised: 10/05/2012] [Accepted: 10/10/2012] [Indexed: 06/01/2023]
Abstract
Cardiac surgery in the pregnant woman gives rise to several anesthetic challenges, as the mother, but mainly the fetus, have a risk of high morbidity and mortality. In this context, the cardiopulmonary bypass is the most complex period, owing to the risks of fetal hypoxia it entails. Due to the absence, for ethical reasons, of prospective trials that provide generally accepted guidelines in intraoperative management, it means that physicians have to work based on case reports in the literature. These procedures also require team coordination to be successful. The case is presented of a 19 weeks pregnant woman, who required a mitral valve replacement, which was achieved with success, and enabled her to complete her pregnancy without complications. Details are provided on the published references on which our management was based.
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Affiliation(s)
- C Rivero
- Servicio de Anestesiología, Hospital de Clínicas, Facultad de Medicina, Universidad de la República, Montevideo, Uruguay.
| | - M Cerizola
- Servicio de Anestesiología, Hospital de Clínicas, Facultad de Medicina, Universidad de la República, Montevideo, Uruguay
| | - E Kohn
- Servicio de Anestesiología, Hospital de Clínicas, Facultad de Medicina, Universidad de la República, Montevideo, Uruguay
| | - J Riva
- Servicio de Anestesiología, Hospital de Clínicas, Facultad de Medicina, Universidad de la República, Montevideo, Uruguay
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Lichtman AD, Kjaer K. Combined Cesarean Delivery and Repair of Acute Ascending and Aortic Arch Dissection at 32 Weeks of Pregnancy. J Cardiothorac Vasc Anesth 2013; 27:731-4. [DOI: 10.1053/j.jvca.2011.11.003] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2011] [Indexed: 11/11/2022]
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Echeverría LE, Figueredo A, Gómez JC, Salazar LA, Rodriguez JA, Pizarro CE, Riaño CE, Perroni A, Cuadros AL, Villamizar MC, Suárez EU. [High risk infective endocarditis embolism during pregnancy: Medical or surgical management?]. ARCHIVOS DE CARDIOLOGIA DE MEXICO 2013; 83:209-13. [PMID: 23896064 DOI: 10.1016/j.acmx.2013.04.012] [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: 09/25/2012] [Revised: 04/04/2013] [Accepted: 04/04/2013] [Indexed: 10/26/2022] Open
Abstract
A 22-year-old pregnant woman was seen at 14 weeks of pregnancy for infective endocarditis with a vegetation of 15 mm and wide mobility, which affected the native mitral valve accompanied by severe valvular insufficiency. Antibiotic treatment was given for 4 weeks despite the embolism risk. Due to persistence of vegetation size and after considering the fetal and maternal risk, the surgical procedure was favored. We decided to perform valvuloplasty and removal of lesion at 18 weeks of pregnancy. Fetal protection techniques were used and a bioprosthesis was placed before attempting a repair. The postoperative follow-up was satisfactory, achieving a successful birth by cesarean section at 30 weeks.
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Affiliation(s)
- Luis Eduardo Echeverría
- Clínica de Falla Cardíaca, Fundación Cardiovascular de Colombia, Floridablanca, Santander, Colombia; Departamento de Ecocardiografía, Fundación Cardiovascular de Colombia, Floridablanca, Santander, Colombia.
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Ruys TPE, Cornette J, Roos-Hesselink JW. Pregnancy and delivery in cardiac disease. J Cardiol 2013; 61:107-12. [PMID: 23290155 DOI: 10.1016/j.jjcc.2012.11.001] [Citation(s) in RCA: 59] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2012] [Accepted: 11/10/2012] [Indexed: 11/24/2022]
Abstract
Although its prevalence is relatively low in pregnant women, heart disease is the most important cause of maternal mortality. Problems may arise due to hemodynamic burden and the hypercoagulable state of pregnancy. Heart disease may be congenital or acquired. In developed countries, the former composes the biggest part of women with heart disease. Patients with unrepaired lesions, cyanotic lesions, diminished systemic ventricular function, complex congenital heart disease, left ventricular outflow tract obstruction, pulmonary hypertension, or mechanical valves are at highest risk of developing complications during pregnancy. All patients with known cardiac disease should preferably be counseled before conception. Pre-pregnancy evaluation should include risk assessment for the mother and fetus, including medication use and information on heredity of the cardiac lesion. Management of pregnancy and delivery should be planned accordingly on individual bases. The types of complications are related to the cardiac diagnosis, with arrhythmias and heart failure being most common. Treatment options should be discussed with the future parents, as they may affect both mother and child. In general, the preferred route of delivery is vaginal. The optimal care for pregnant women with heart disease requires multidisciplinary involvement and is best concentrated in tertiary centers.
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Affiliation(s)
- Titia P E Ruys
- Department of Cardiology, Erasmus Medical Center, Rotterdam, The Netherlands.
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Pieper PG, Hoendermis ES, Drijver YN. Cardiac surgery and percutaneous intervention in pregnant women with heart disease. Neth Heart J 2012; 20:125-8. [PMID: 22351585 PMCID: PMC3286507 DOI: 10.1007/s12471-012-0244-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
In pregnant women with heart disease, complications can arise due to the haemodynamic burden of pregnancy and to hypercoagulation. Most problems can be managed medically, but sometimes cardiac surgery or percutaneous intervention is unavoidable. Cardiac surgery has similar maternal mortality to that outside pregnancy, but foetal mortality and morbidity are considerable. Measures to reduce the risk by adaptation of the management of cardiopulmonary bypass are described. When gestational age is > 28 weeks, pre-surgery delivery of the foetus should be considered. Percutaneous intervention exposes the foetus to radiation. The radiation dose for common cardiac procedures, however, does not result in detectable harmful foetal effects.
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Affiliation(s)
- P G Pieper
- Department of Cardiology, University Medical Centre Groningen, University of Groningen, PO Box 30.001, 9700, RB, Groningen, the Netherlands,
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Wolff GA, Weitzel NS. Management of acquired cardiac disease in the obstetric patient. Semin Cardiothorac Vasc Anesth 2011; 15:85-97. [PMID: 21994133 DOI: 10.1177/1089253211420302] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Physiologic changes incurred by pregnancy can cause severe decompensation in the parturient with underlying cardiac disease. The result is increased morbidity and mortality for both mother and child. Appropriate anesthetic management can significantly impact these outcomes. This review systematically presents the pathophysiology, peripartum risk, and anesthetic management in the puerperium of specific acquired cardiac abnormalities including: valvular disease, pulmonary hypertension, cardiomyopathy, cardiac transplantation, ischemia, arrhythmias, and cardiac arrest.
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Affiliation(s)
- Andrea J Carpenter
- Division of Thoracic Surgery, University of Texas Health Science Center, San Antonio, 7703 Floyd Curl Dr, MC 7841, San Antonio, TX 78229, USA.
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Mokgwathi GT, Lebakeng EM, Ogunbanjo GA. Positive maternal and foetal outcomes after cardiopulmonary bypass surgery in a parturient with severe mitral valve disease. SOUTHERN AFRICAN JOURNAL OF ANAESTHESIA AND ANALGESIA 2011. [DOI: 10.1080/22201173.2011.10872795] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Affiliation(s)
- GT Mokgwathi
- Department of Anaesthesiology, University of Limpopo (Medunsa Campus)
| | - EM Lebakeng
- Department of Anaesthesiology, University of Limpopo (Medunsa Campus)
| | - GA Ogunbanjo
- Department of Family Medicine and Primary Health Care, University of Limpopo (Medunsa Campus)
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