1
|
Agarwal A, Murkey SP, Pandit P, Jaiswal A, Agrawal S. Navigating the Complexity: A Comprehensive Review of Managing Pregnancy in Complete Heart Block Cases. Cureus 2023; 15:e50977. [PMID: 38259400 PMCID: PMC10801392 DOI: 10.7759/cureus.50977] [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: 11/21/2023] [Accepted: 12/22/2023] [Indexed: 01/24/2024] Open
Abstract
This review explores the comprehensive management of pregnancy in cases of complete heart block, a cardiac condition characterized by the dissociation between atrial and ventricular conduction. The review begins with a thorough examination of preconception counseling, emphasizing the assessment of maternal health, the evaluation of cardiac function, and the identification of potential risks. Subsequently, the medical management section delves into using beta-blockers, pacemakers, and antiarrhythmic drugs to monitor cardiac function during pregnancy and adjust medication regimens. Obstetric considerations highlight the importance of antenatal care, fetal monitoring, and thoughtful delivery planning, including the choice between vaginal delivery and cesarean section. The section on complications underscores the risks of arrhythmias, heart failure, premature birth, and neonatal cardiac issues. Looking ahead, the future directions and research section explores ongoing studies in genetics, pharmacology, and technological innovations, envisioning potential advancements in pacing technology and personalized medicine approaches. The conclusion synthesizes key findings, offering recommendations for clinical practice and reflecting on the challenges and opportunities inherent in managing pregnancy in complete heart block cases. The multidisciplinary approach emerges as paramount, with collaborative efforts paving the way for improved patient outcomes and advancements in the field.
Collapse
Affiliation(s)
- Akash Agarwal
- Surgery, Jawaharlal Nehru Medical College, Wardha, IND
| | | | - Pranam Pandit
- Medicine, Jawaharlal Nehru Medical College, Wardha, IND
| | - Arpita Jaiswal
- Obstetrics and Gynecology, Jawaharlal Nehru Medical College, Wardha, IND
| | | |
Collapse
|
2
|
Kohli U, Perrotta ML, Aljemmali S, Sosnowski C, Cardenas YM, Sharma K. Dichorionic Diamniotic Twin Pairs with Complex Congenital Heart Disease. Pediatr Cardiol 2023:10.1007/s00246-023-03339-y. [PMID: 37964109 DOI: 10.1007/s00246-023-03339-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2022] [Accepted: 10/25/2023] [Indexed: 11/16/2023]
Abstract
Complex congenital heart disease (CHD) in each of dichorionic diamniotic (DiDi) twin pairs is extremely rare and has not been well characterized. Four DiDi twin pairs were included in this multi-institutional case series. The congenital cardiac abnormalities noted included tetralogy of Fallot (ToF) with pulmonary atresia and collaterals (n = 1), ToF with absent pulmonary valve (n = 1), ToF (n = 2), discontinuous right pulmonary artery (RPA) (n = 1), tricuspid atresia (TA) with normally related great arteries and pulmonary valve stenosis or atresia (n = 2) and coarctation of aorta (CoA) with bicuspid aortic valve (BAV) and borderline left-sided structures (n = 1). Genetic testing was obtained on seven of the eight twins but did not reveal any causal abnormality. A comprehensive review of literature yielded another 8 DiDi twin pairs with complex CHD. The CHD noted in these twin pairs included ToF (n = 2), CoA (n = 4), corrected transposition of great arteries (ccTGA) (n = 2), truncus arteriosus (n = 2), complete common atrioventricular canal (CCAVC) (n = 2), hypoplastic left heart syndrome (HLHS) (n = 2), Shone's complex (n = 1), and hypoplastic right heart syndrome (HRHS) (n = 1). Limited genetic testing was obtained on 4 of these twins and revealed trisomy 21 in a twin pair. Conotruncal abnormalities (42%), CoA (21%), and abnormalities of the right ventricle, the right ventricular outflow tract and pulmonary arteries (17%) are more prevalent in DiDi twins with complex CHD. Clustering of these abnormalities suggests a possible genetic basis; however, genetic testing was obtained on eleven of the twins, and except for trisomy 21 in a twin pair both of whom had CCAVC, did not reveal any causal abnormality. A major direct genetic contribution is therefore unlikely and like other CHD, the underlying etiopathological basis is likely multifactorial.
Collapse
Affiliation(s)
- Utkarsh Kohli
- Department of Pediatrics, Division of Pediatric Cardiology, West Virginia University Children's Hospital and West Virginia University School of Medicine, 64 Medical Center Drive, Robert C. Byrd Health Sciences Center, PO Box 9214, Morgantown, WV, 26506, USA.
| | - Melissa L Perrotta
- Department of Pediatrics, Division of Pediatric Cardiology, University of Louisville School of Medicine and Norton Children's Hospital, Louisville, KY, 40202, USA
| | - Saif Aljemmali
- Department of Pediatrics, Section of Pediatric Cardiology, Rush University Medical Center, Chicago, IL, 60612, USA
| | - Cyndi Sosnowski
- Department of Pediatrics, Section of Pediatric Cardiology, Rush University Medical Center, Chicago, IL, 60612, USA
| | - Yvonne M Cardenas
- Department of Pediatrics, Division of Pediatric Cardiology, West Virginia University Children's Hospital and West Virginia University School of Medicine, 64 Medical Center Drive, Robert C. Byrd Health Sciences Center, PO Box 9214, Morgantown, WV, 26506, USA
| | - Kavita Sharma
- Department of Pediatrics, Children's Medical Center Dallas, University of Texas Southwestern Medical Center, Dallas, TX, 75390, USA
| |
Collapse
|
3
|
Ali F, Wazir HD, AKBAR ALI, Khan AM, Rehman Y, Hussain I, Gul H, Ullah I, Khan K, Afridi AK. Frequency of Congenital Cardiac Disease in Various Divisions of Khyber Pakhtunkhwa (KPK) Based on a Six-Month Analysis of Inpatients at a Tertiary Care Hospital’s Pediatric Cardiology Unit. Cureus 2023; 15:e35209. [PMID: 36968943 PMCID: PMC10032550 DOI: 10.7759/cureus.35209] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/20/2023] [Indexed: 02/22/2023] Open
Abstract
OBJECTIVE To identify the frequency of congenital heart disease (CHD) in various Khyber Pakhtunkhwa (KPK) divisions. MATERIALS AND METHODS To perform this research, we reviewed the medical records of pediatric cardiology patients hospitalized between January 2022 and July 2022. Data was taken from the cardiology department's computerized data system between January 1 and July 31, 2022. To prevent any errors in diagnosis and address them during input by the ward clerk, patients' addresses, diagnoses, and gender were verified with the computerized medical record. Data were analyzed, and frequency and percentages were calculated. Per the digital mapping of KPK districts, we stratified and examined the data among various KPK divisions. RESULTS Out Of the 371 patients with CHD who were admitted, 36.98% (137) were from the Peshawar division, 28.84% (107) from the Malakand division, 16.71% (62) from the Mardan division, 6.1% (23) from the Kohat division, 4.3% (16) from the Bannu division, 3.5% (13) from the Dera Ismail Khan division, and 3.5% (13) from the Hazara division. A total of 371 had CHD, of which 234 (63.07%) were cyanotic and 137 (36.92%) were cyanotic. The most prevalent acynotic congenital heart defect was patent ductus arteriosus (PDA) at 36.32% (85), followed by a ventricular septal defect (VSD) at 35.04 (82). The most frequent acyanotic congenital cardiac abnormality was tetralogy of Fallot (TOF) at 49.63% (68), which was followed by transposition of the great arteries (TGA) at 33.57% (46). CONCLUSION In KPK, congenital heart disease is most prevalent in the divisions of Peshawar and Malakand, while it is least prevalent in Hazara.
Collapse
|
4
|
Altendahl M, Mok T, Adimkpayah E, Goldstein J, Lin J, Afshar Y. Vascular malperfusion and abruption are prevalent in placentas from pregnancies with congenital heart disease and not associated with cardiovascular risk. Sci Rep 2023; 13:1439. [PMID: 36697426 PMCID: PMC9876959 DOI: 10.1038/s41598-023-28011-6] [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: 08/18/2022] [Accepted: 01/11/2023] [Indexed: 01/26/2023] Open
Abstract
Congenital heart disease (CHD) in pregnancy is associated with an increased risk of adverse maternal, obstetric, and neonatal outcomes, plausibly through mechanisms involving abnormal placental development and function. This retrospective study aims to elucidate how maternal CHD influences placental health. Demographic and clinical information were collected via electronic medical record review, and placentas underwent histopathological evaluation. Fifty-three singleton pregnancies were included: 35 participants (66%) were classified as lower cardiovascular risk (modified World Health Organization Classification (mWHO) I, II, II-III), and 18 (34%) were classified as higher cardiovascular risk (mWHO III, IV). 12 participants (23%) had a fetus with small for gestational age (SGA). Maternal vascular malperfusion (53%) and placental abruption (11.6%) were common in this cohort, with prevalence above baseline risk. Participants at higher cardiovascular risk had higher rates of SGA (p = 0.04), subchorionic hematomas (p = 0.01) and birth weight:placental weight < 10th percentile (p = 0.04), but did not differ in rates of maternal vascular malperfusion (p = 0.15) compared to those at lower cardiovascular risk. In pregnancies with maternal CHD, SGA and histologic evidence of maternal vascular malperfusion and placental abruption were common, though patients at higher cardiovascular risk did not show evidence of worsened placental health compared to those at lower risk.
Collapse
Affiliation(s)
- Marie Altendahl
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Thalia Mok
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Ekene Adimkpayah
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Jeffrey Goldstein
- Department of Pathology and Laboratory Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Jeannette Lin
- Division of Cardiology, Department of Medicine, Ahmanson/UCLA Adult Congenital Heart Disease Center, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Yalda Afshar
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA.
| |
Collapse
|
5
|
|
6
|
Choi EY, Kim ES, Kim JY, Song MK, Kim SH, Noh CI. Pregnancy outcomes in patients with structural heart disease: a single center experience. Cardiovasc Diagn Ther 2021; 11:81-90. [PMID: 33708480 DOI: 10.21037/cdt-20-786] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Background In women, pregnancy is a period of relatively drastic hemodynamic change in a short period of time. Most pregnant women adapt well to these gradual hemodynamic changes. However, in women with congenital heart disease or other structural heart disease, adaptation to theses sudden hemodynamic changes is difficult, and heart failure or arrhythmia can get aggravated. This study shares our experiences on the outcomes of pregnancy in patients with structural heart disease. Methods From January 2007 to December 2016, we reviewed the medical records of all pregnant women with structural heart disease who received obstetric care at the Sejong General Hospital. Results During the study period, 103 pregnancies were observed in 79 women with structural heart disease. Of the 103 pregnancies, 55 were primiparous and 48 were multiparous. Echocardiography performed before pregnancy revealed that 52 patients had moderate to severe valvular regurgitation and 38 patients had moderate to severe valvular stenosis; 22 patients had mechanical valves and 5 patients had pulmonary hypertension. Overall, there were 9 maternal cardiac events, 7 obstetric events and 19 neonatal events. Pulmonary embolic events occurred only in 1 case; 77 deliveries were made, and 26 pregnancies did not last. Among 77 deliveries, 55 patients delivered by cesarean section (C/S) (71.43%). C/S in 16 of 55 patients was performed due to the maternal hemodynamic risk. Conclusions Overall complications associated with pregnancy in women with structural heart disease were very high at 28.16%. However, it is hoped that maternal and neonatal outcomes will be improved through careful observation and preparedness for anticipated complications.
Collapse
Affiliation(s)
- Eun-Young Choi
- Department of Pediatrics, College of Medicine, Kangwon National University, Gangwon-do, Korea.,Department of Pediatrics, Sejong General Hospital, Gyeonggi-do, Korea
| | - Eun Sun Kim
- Department of Pediatrics, College of Medicine, Kangwon National University, Gangwon-do, Korea
| | - Jung-Yoon Kim
- Department of Pediatrics, Sejong General Hospital, Gyeonggi-do, Korea
| | - Min-Kyung Song
- Department of Obstetrics and Gynecology, Sejong General Hospital, Gyeonggi-do, Korea
| | - Seong-Ho Kim
- Department of Pediatrics, Sejong General Hospital, Gyeonggi-do, Korea
| | - Chung Il Noh
- Department of Pediatrics, Sejong General Hospital, Gyeonggi-do, Korea
| |
Collapse
|
7
|
Saito K, Toyama H, Okamoto A, Yamauchi M. Management of cesarean section in a patient with Fontan circulation: a case report of dramatic reduction of maternal oxygen consumption after delivery. JA Clin Rep 2020; 6:77. [PMID: 33011935 PMCID: PMC7533274 DOI: 10.1186/s40981-020-00385-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2020] [Revised: 09/15/2020] [Accepted: 09/29/2020] [Indexed: 12/01/2022] Open
Abstract
Background The anesthetic management of cesarean sections in Fontan-palliated parturients requires strict hemodynamic control. However, patient management with central venous oxygen saturation (ScvO2) and oxygen consumption (VO2) has never been reported. Case presentation A 30-year-old woman, who had received a total cavopulmonary connection for tricuspid atresia, was planned to undergo cesarean section at 38 weeks’ gestation. During combined spinal-epidural anesthesia, ScvO2 in addition to arterial pressure-based cardiac output (APCO) and central venous pressure (CVP) was monitored, and the change of VO2 was evaluated. After delivery, her APCO was almost unchanged. However, her ScvO2 increased dramatically from 42.1 to 67.3% and her CVP increased from 9 to 11 mm Hg. The calculated mean maternal VO2 changed from 443 to 295 mL/min. Conclusions In a cesarean section for a Fontan-palliated parturient, ScvO2 dramatically increased and maternal VO2 decreased by more than 25% after delivery.
Collapse
Affiliation(s)
- Kazutomo Saito
- Anesthesiology and Perioperative Medicine, Tohoku University Graduate School of Medicine, 2-1 Seiryomachi, Aoba-ku, Sendai, Miyagi, 980-8575, Japan.
| | - Hiroaki Toyama
- Anesthesiology and Perioperative Medicine, Tohoku University Graduate School of Medicine, 2-1 Seiryomachi, Aoba-ku, Sendai, Miyagi, 980-8575, Japan
| | - Atsushi Okamoto
- Department of Anesthesiology, Tohoku University Hospital, 1-1 Seiryomachi, Aoba-ku, Sendai, Miyagi, 980-8575, Japan
| | - Masanori Yamauchi
- Anesthesiology and Perioperative Medicine, Tohoku University Graduate School of Medicine, 2-1 Seiryomachi, Aoba-ku, Sendai, Miyagi, 980-8575, Japan
| |
Collapse
|
8
|
Ikeda N, Hatano M, Nagamatsu T, Nakamura M. Successful right heart remodelling and subsequent pregnancy in a patient with chronic thromboembolic pulmonary hypertension undergoing balloon pulmonary angioplasty: a case report. EUROPEAN HEART JOURNAL-CASE REPORTS 2019; 3:5485826. [PMID: 31449621 PMCID: PMC6601160 DOI: 10.1093/ehjcr/ytz063] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/16/2018] [Accepted: 04/10/2019] [Indexed: 11/14/2022]
Abstract
Background To date, the management of pregnancy in patients with chronic thromboembolic pulmonary hypertension (CTEPH) and the associated risk of maternal mortality have not been established. Although balloon pulmonary angioplasty (BPA) in patients with CTEPH is still an emerging procedure, this approach represents a promising alternative to pulmonary endarterectomy (PEA), especially in patients with inoperable CTEPH. Case summary We present a case of a 34-year-old woman with CTEPH who desired to have a child. Right heart catheterization showed a mean pulmonary artery pressure of 54 mmHg. Since the lesions were observed in the distal part of subsegmental pulmonary arteries, there was no indication for PEA. After improvement in her haemodynamic status by BPA, she became pregnant. At 40 weeks of gestation, a normal baby was delivered vaginally. Both mother and baby have made satisfactory progress. Discussion In cases in which the haemodynamic status is improved by effective BPA, pregnancy and childbirth may be possible, even in patients with CTEPH.
Collapse
Affiliation(s)
- Nobutaka Ikeda
- Division of Cardiovascular Medicine, Toho University Ohashi Medical Center, 2-22-36 Ohashi, Meguro-ku, Tokyo, Japan
| | - Masaru Hatano
- Department of Therapeutic Strategy for Heart Failure, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongou, Bunkyo-ku, Tokyo, Japan
| | - Takeshi Nagamatsu
- Department of Obstetrics and Gynecology, Faculty of Medicine, The University of Tokyo, 7-3-1 Hongou, Bunkyo-ku, Tokyo, Japan
| | - Masato Nakamura
- Division of Cardiovascular Medicine, Toho University Ohashi Medical Center, 2-22-36 Ohashi, Meguro-ku, Tokyo, Japan
| |
Collapse
|
9
|
Clennon EK, Pare E, Amato P, Caughey AB. Use of gestational surrogates for women with Eisenmenger syndrome: a cost-effectiveness analysis. J Matern Fetal Neonatal Med 2019; 34:526-531. [PMID: 31006283 DOI: 10.1080/14767058.2019.1610734] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Objective: Eisenmenger syndrome (ES) is regarded as a contraindication to pregnancy, with therapeutic abortion recommended in the event of unintended pregnancy. However, women with ES continue to desire and attempt pregnancy despite grave risks to their own health. This study compares the costs and outcomes of pregnancy in women with ES to the use of gestational surrogates in their pregnancies.Study design: A decision-analytic model was built using TreeAge software that compared use of gestational surrogates and pregnancy in women with ES. Maternal death and neonatal outcomes including intrauterine fetal demise, preterm birth, cerebral palsy, and death were assessed. All probabilities and costs were derived from the literature. Utilities were discounted at a rate of 3% across the expected lifespan to generate quality-adjusted life years (QALYs). Univariate and multivariate sensitivity analyses were performed to evaluate the robustness of the model given changes in baseline assumptions.Results: In a theoretical cohort of 1000 women with ES, pregnancy would result in 360 maternal deaths, 100 stillbirths, 477 preterm births, and 157 neonatal deaths . In these highly desired pregnancies, use of gestational surrogates would prevent 99 and 98% of maternal and neonatal death, respectively. Cases and costs of preterm birth and associated cerebral palsy are also significantly reduced. Use of a gestational surrogate would save $518,255 per woman with a gain of 6.77 QALYs, a dominant strategy. The approach is cost-effective up to a cost of surrogacy of $1.2 million and even if the surrogate achieves pregnancy only 30% of the time.Conclusions: The use of surrogate mothers for those with ES is cost-effective and results in significantly improved maternal and neonatal outcomes. These benefits are robust in the face of high surrogacy costs largely due to the marked reduction in maternal mortality and preterm birth. These findings should be used to underscore the importance of broadening health care financing for medically-indicated assisted reproduction.
Collapse
Affiliation(s)
- Emily K Clennon
- Department of Obstetrics and Gynecology, Oregon Health & Sciences University, Portland, OR, USA
| | - Emmanuelle Pare
- Department of Obstetrics and Gynecology, Oregon Health & Sciences University, Portland, OR, USA
| | - Paula Amato
- Department of Obstetrics and Gynecology, Oregon Health & Sciences University, Portland, OR, USA
| | - Aaron B Caughey
- Department of Obstetrics and Gynecology, Oregon Health & Sciences University, Portland, OR, USA
| |
Collapse
|
10
|
Mamedguseyinova SS, Lapochkina ND, Matyushkov NS, Kokorin VA, Gordeev IG, Grishina IS, Konysheva ОV, Averkov ОV. INDIVIDUAL APPROACH TO MANAGEMENT OF PREGNANCY IN WOMAN WITH PROSTETIC HEART VALVE THROMBOSIS. КАРДИОВАСКУЛЯРНАЯ ТЕРАПИЯ И ПРОФИЛАКТИКА 2018. [DOI: 10.15829/1728-8800-2018-2-63-67] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
In the clinical case, an individual approach is demonstrated to management of mechanical aortic valve thrombosis. The specifics of the case is in 1213 weeks pregnancy of the patient, in aggressive antithrombotic therapy, absence of hemorrhagic complications and complications of the fetus.
Collapse
Affiliation(s)
| | - N. D. Lapochkina
- N. I. Pirogov Russian National Research Medical University (RNRMU)
| | | | - V. A. Kokorin
- N. I. Pirogov Russian National Research Medical University (RNRMU)
| | - I. G. Gordeev
- N. I. Pirogov Russian National Research Medical University (RNRMU)
| | | | | | - О. V. Averkov
- N. I. Pirogov Russian National Research Medical University (RNRMU); City Clinical Hospital № 15 n. a. O. M. Filatov
| |
Collapse
|
11
|
Moroney E, Posma E, Dennis A, d'Udekem Y, Cordina R, Zentner D. Pregnancy in a woman with a Fontan circulation: A review. Obstet Med 2017; 11:6-11. [PMID: 29636807 DOI: 10.1177/1753495x17737680] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2017] [Accepted: 09/23/2017] [Indexed: 11/15/2022] Open
Abstract
More women with congenital heart disease survive to childbearing ages, due to improvements in surgical practice and postoperative care. This review discusses pregnancy in women with a single ventricle, describing maternal obstetric and cardiovascular complications and the increased risks of prematurity and adverse neonatal outcomes. Recommendations are made based on current understanding, guidelines and published literature, with recognition that there is much knowledge yet to be gained.
Collapse
Affiliation(s)
- Emily Moroney
- Murdoch Children's Research Institute, Melbourne, Australia.,Department of Paediatrics, The University of Melbourne, Melbourne, Australia
| | - Elske Posma
- Department of Obstetrics and Gynaecology, The Royal Women's Hospital, Victoria, Australia
| | - Alicia Dennis
- Department of Anaesthesia, The Royal Women's Hospital, Victoria, Australia.,Department of Obstetrics and Gynaecology, The University of Melbourne, Melbourne, Australia.,Department of Pharmacology, The University of Melbourne, Melbourne, Australia
| | - Yves d'Udekem
- Murdoch Children's Research Institute, Melbourne, Australia.,Department of Paediatrics, The University of Melbourne, Melbourne, Australia.,7Department of Cardiac Surgery, Royal Children's Hospital Melbourne, Melbourne, Australia
| | - Rachael Cordina
- Department of Cardiology, Royal Prince Alfred Hospital, Sydney, NSW, Australia.,Central Clinical School, The University of Sydney, Camperdown, NSW, Australia
| | - Dominica Zentner
- Department of Cardiology, The Royal Melbourne Hospital, Victoria, Australia.,Department of Medicine Royal Melbourne Hospital, University of Melbourne, Melbourne, Australia
| |
Collapse
|
12
|
Nayak SB. Functional and clinical importance of a large sized ostium secundum defect in a middle aged female cadaver: a case report. Anat Cell Biol 2017; 50:152-154. [PMID: 28713619 PMCID: PMC5509899 DOI: 10.5115/acb.2017.50.2.152] [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: 03/03/2017] [Revised: 03/28/2017] [Accepted: 04/07/2017] [Indexed: 11/27/2022] Open
Abstract
Atrial septal defect (ASD) is one of the common congenital anomalies of the heart in humans. Its complications depend on the size of the defect and can manifest at any age. The common symptoms of ASD include dyspnea and fatigue. Most of the ASDs are associated with morbidity and mortality, Earlier the treatment, it is better to the patient. I saw a large ostium secundum defect in the heart of an adult female cadaver during dissection classes for undergraduate medical students. The interatrial septum had large defect at the region where fossa ovalis should have been located. It was about 1.25 inches in diameter and oval in shape. This type of large septal defect might result in cyanosis, stroke or death of the patient at any age.
Collapse
Affiliation(s)
- Satheesha B Nayak
- Department of Anatomy, Melaka Manipal Medical College (Manipal Campus), Manipal University, Manipal, India
| |
Collapse
|
13
|
Shah RB, Butala BP, Parikh GP. Anesthetic Management of a Parturient with Severe Pulmonary Restenosis Posted for Cesarean Section. Anesth Essays Res 2017; 11:517-519. [PMID: 28663653 PMCID: PMC5490144 DOI: 10.4103/0259-1162.194570] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Adults with congenital heart disease are increasing due to improvement in infant heart surgery and availability of better cardiac care. Pregnancy in these patients requires multidisciplinary team approach due to circulatory changes. We describe an anesthetic management of the parturient undergoing cesarean section having severe pulmonary restenosis.
Collapse
Affiliation(s)
- Rajkiran Babubhai Shah
- Department of Anaesthesiology and Critical Care, Institute of Kidney Disease and Research Centre, Ahmedabad, Gujarat, India
| | - Beena P Butala
- Department of Anaesthesiology and Critical Care, Institute of Kidney Disease and Research Centre, Ahmedabad, Gujarat, India
| | - Geeta P Parikh
- Department of Anaesthesiology and Critical Care, Institute of Kidney Disease and Research Centre, Ahmedabad, Gujarat, India
| |
Collapse
|
14
|
Catarci S, Sbaraglia F, Zanfini BA, Vagnoni S, Frassanito L, Draisci G. Combined spinal-epidural anesthesia for urgent cesarean section in a parturient with a single ventricle: a case report. Korean J Anesthesiol 2016; 69:632-634. [PMID: 27924207 PMCID: PMC5133238 DOI: 10.4097/kjae.2016.69.6.632] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2015] [Revised: 12/12/2015] [Accepted: 12/29/2015] [Indexed: 11/10/2022] Open
Abstract
The number of women with major congenital heart defects reaching reproductive age is likely increasing. We herein describe the anesthetic management of a 33-year-old woman at 37 gestational weeks with a history of Glenn surgery who was undergoing an urgent cesarean section due to pathological cardiotocography. Combined spinal-epidural anesthesia was the most suitable technique for urgent cesarean section in our patient with a single ventricle and phasic flow in the pulmonary artery because it provided rapid-onset anesthesia with negligible hemodynamic effects.
Collapse
Affiliation(s)
- Stefano Catarci
- Department of Anesthesiology and Intensive Care, Sacro Cuore Catholic University, Rome, Italy
| | - Fabio Sbaraglia
- Department of Anesthesiology and Intensive Care, Sacro Cuore Catholic University, Rome, Italy
| | - Bruno Antonio Zanfini
- Department of Anesthesiology and Intensive Care, Sacro Cuore Catholic University, Rome, Italy
| | - Salvatore Vagnoni
- Department of Anesthesiology and Intensive Care, Sacro Cuore Catholic University, Rome, Italy
| | - Luciano Frassanito
- Department of Anesthesiology and Intensive Care, Sacro Cuore Catholic University, Rome, Italy
| | - Gaetano Draisci
- Department of Anesthesiology and Intensive Care, Sacro Cuore Catholic University, Rome, Italy
| |
Collapse
|
15
|
Thompson JL, Kuklina EV, Bateman BT, Callaghan WM, James AH, Grotegut CA. Medical and Obstetric Outcomes Among Pregnant Women With Congenital Heart Disease. Obstet Gynecol 2015; 126:346-354. [PMID: 26241425 PMCID: PMC4605664 DOI: 10.1097/aog.0000000000000973] [Citation(s) in RCA: 63] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To estimate nationwide trends in the prevalence of maternal congenital heart disease (CHD) and determine whether women with CHD are more likely than women without maternal CHD to have medical and obstetric complications. METHODS The 2000-2010 Nationwide Inpatient Sample was queried for International Classification of Diseases, 9th Revision, Clinical Modification codes to identify delivery hospitalizations of women with and without CHD. Trends in the prevalence of CHD were determined and then rates of complications were reported for CHD per 10,000 delivery hospitalizations. For Nationwide Inpatient Sample 2008-2010, logistic regression was used to examine associations between CHD and complications. RESULTS From 2000 to 2010, there was a significant linear increase in the prevalence of CHD from 6.4 to 9.0 per 10,000 delivery hospitalizations (P<.001). Multivariable logistic regression demonstrated that all selected medical complications, including mortality (17.8 compared with 0.7/10,000 deliveries, adjusted odds ratio [OR] 22.10, 95% confidence interval [CI] 13.96-34.97), mechanical ventilation (91.9 compared with 6.9/10,000, adjusted OR 9.94, 95% CI 7.99-12.37), and a composite cardiovascular outcome (614 compared with 34.3/10,000, adjusted OR 10.54, 95% CI 9.55-11.64) were more likely to occur among delivery hospitalizations with maternal CHD than without. Obstetric complications were also common among women with CHD. Delivery hospitalizations with maternal CHD that also included codes for pulmonary circulatory disorders had higher rates of medical complications compared with hospitalizations with maternal CHD without pulmonary circulatory disorders. CONCLUSION The number of delivery hospitalizations with maternal CHD in the United States is increasing, and although we were not able to determine whether correction of the cardiac lesion affected outcomes, these hospitalizations have a high burden of medical and obstetric complications. LEVEL OF EVIDENCE II.
Collapse
Affiliation(s)
- Jennifer L Thompson
- Division of Maternal-Fetal Medicine, Duke University, Durham, North Carolina; the Division of Reproductive Health, Centers for Disease Control and Prevention, Atlanta, Georgia; and the Department of Anesthesia, Critical Care and Pain Management, Massachusetts General Hospital, Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | | | | | | | | | | |
Collapse
|
16
|
Wald RM, Sermer M, Colman JM. Pregnancy and contraception in young women with congenital heart disease: General considerations. Paediatr Child Health 2012; 16:e25-9. [PMID: 22468131 DOI: 10.1093/pch/16.4.e25] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/03/2010] [Indexed: 11/13/2022] Open
Abstract
Young women with heart disease are increasingly being seen in obstetrical referral centres owing, in large part, to the dramatic improvements in survival of young adults with congenital heart disease in recent years. Although pregnancies in most women with heart disease result in favourable outcomes, there are important exceptions that must be recognized. These exceptions pose significant mortality risk to the mother and/or the fetus. The present article outlines cardiovascular adaptations to pregnancy, general outcomes and management considerations for practitioners caring for pregnant young women with congenital heart disease. A lesion-specific review is published in a complementary article.
Collapse
Affiliation(s)
- Rachel M Wald
- Toronto General Hospital, Mount Sinai Hospital and Toronto Congenital Cardiac Centre for Adults, University Health Network
| | | | | |
Collapse
|
17
|
Godosis D, Komaitis S, Tziomalos K, Baltatzi M, Ntaios G, Savopoulos CG, Hatzitolios AI. Cardiοvascular diseases in pregnancy. AMERICAN JOURNAL OF CARDIOVASCULAR DISEASE 2012; 2:96-101. [PMID: 22720198 PMCID: PMC3371626] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 01/31/2012] [Accepted: 03/11/2012] [Indexed: 06/01/2023]
Abstract
Gestation is a period of significant physiological changes that can severely affect the function of many systems, including the cardiovascular. The deviation from the standard that occurs during pregnancy may cause the deterioration of pre-existent cardiovascular diseases or the appearance of new ones. In this review we will present the most common congenital and acquired cardiovascular diseases, their clinical expression and therapeutic procedures according to the latest international guidelines.
Collapse
Affiliation(s)
- Dimitrios Godosis
- 1 Medical Propedeutic Department, Medical School, Aristotles University of Thessaloniki, AHEPA Hospital Thessaloniki, Greece
| | | | | | | | | | | | | |
Collapse
|
18
|
Oechslin E, Mebus S, Schulze-Neick I, Niwa K, Trindade PT, Eicken A, Hager A, Lang I, Hess J, Kaemmerer H. The Adult Patient with Eisenmenger Syndrome: A Medical Update after Dana Point Part III: Specific Management and Surgical Aspects. Curr Cardiol Rev 2011; 6:363-72. [PMID: 22043213 PMCID: PMC3083818 DOI: 10.2174/157340310793566127] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2010] [Revised: 05/06/2010] [Accepted: 05/15/2010] [Indexed: 11/22/2022] Open
Abstract
Eisenmenger syndrome is the most severe form of pulmonary arterial hypertension and arises on the basis of congenital heart disease with a systemic-to-pulmonary shunt. Due to the chronic slow progressive hypoxemia with central cyanosis, adult patients with the Eisenmenger syndrome suffer from a complex and multisystemic disorder including coagulation disorders (bleeding complications and paradoxical embolisms), renal dysfunction, hypertrophic osteoarthropathy, heart failure, reduced quality of life and premature death. For a long time, therapy has been limited to symptomatic options or lung or combined heart-lung transplantation. As new selective pulmonary vasodilators have become available and proven to be beneficial in various forms of pulmonary arterial hypertension, this targeted medical treatment has been expected to show promising effects with a delay of deterioration also in Eisenmenger patients. Unfortunately, data in Eisenmenger patients suffer from small patient numbers and a lack of randomized controlled studies. To optimize the quality of life and the outcome, referral of Eisenmenger patients to spezialized centers is required. In such centers, specific interdisciplinary management strategies of physicians specialized on congenital heart diseases and PAH should be warranted. This medical update emphasizes the current diagnostic and therapeutic options for Eisenmenger patients with particularly focussing on specific management and surgical aspects.
Collapse
Affiliation(s)
- Erwin Oechslin
- Congenital Cardiac Centre for Adults, University Health Network/Toronto General Hospital/Peter Munk Cardiac Centre, 585 University Avenue, Toronto, ON. M5G 2N2, Canada
| | | | | | | | | | | | | | | | | | | |
Collapse
|
19
|
Uebing A, Gatzoulis MA, von Kaisenberg C, Kramer HH, Strauss A. Congenital heart disease in pregnancy. DEUTSCHES ARZTEBLATT INTERNATIONAL 2008; 105:347-54. [PMID: 19629245 DOI: 10.3238/arztebl.2008.0347] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/02/2007] [Accepted: 01/15/2008] [Indexed: 12/18/2022]
Abstract
INTRODUCTION Pregnancy, birth, and the puerperium are associated with significant physiological changes and adaptations in the cardiovascular system, which pose a significant risk to pregnant women with congenital heart disease (CHD). Thanks to advances in pediatric cardiac surgery and cardiology the majority of children with CHD survive to adulthood, and an increasing number eventually become pregnant. In fact, cardiac disease - mostly congenital - is now a leading cause of maternal death in western industrialized countries. METHODS Selective literature review. RESULTS AND DISCUSSION Optimal care of women with CHD before, during, and after pregnancy requires a multidisciplinary team including obstetricians, cardiologists, and anaesthetists. Successful pregnancy at a minimum risk is feasible for most women with CHD when appropriate counseling and optimal care are provided.
Collapse
|
20
|
Ghatpande SK, Billington CJ, Rivkees SA, Wendler CC. Hypoxia induces cardiac malformations via A1 adenosine receptor activation in chicken embryos. BIRTH DEFECTS RESEARCH. PART A, CLINICAL AND MOLECULAR TERATOLOGY 2008; 82:121-30. [PMID: 18186126 PMCID: PMC3752680 DOI: 10.1002/bdra.20438] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND The current understanding of the effects of hypoxia on early embryogenesis is limited. Potential mediators of hypoxic effects include adenosine, which increases dramatically during hypoxic conditions and activates A(1) adenosine receptors (A(1)ARs). METHODS To examine the influences of hypoxia and adenosine signaling on cardiac development, chicken embryos were studied. Real time RT-PCR assay was used to examine the A(1)AR gene expression during embryogenesis and after siRNA- mediated knock down. Cell proliferation was determined by counting cell nuclei and PhosphoHistone H3 positive cells. Apoptosis was determined by TUNEL assay. RESULTS A(1)ARs were found to be expressed in chicken embryos during early embryogenesis. Treatment of Hamburger and Hamilton stage 4 embryos with the A(1)AR agonist N(6)-cyclopentyladenosine caused cardiac bifida and looping defects in 55% of embryos. Hamburger and Hamilton stage 4 embryos exposed to 10% oxygen for 6, 12, 18, and 24 h followed by recovery in room air until stage 11, exhibited cardia bifida and looping defects in 34, 45, 60, and 86% of embryos respectively. Hypoxia-induced abnormalities were reduced when A(1)AR signaling was inhibited by the A(1)AR antagonist 1,3 dipropyl-8-cyclopentylxanthine or by siRNA-targeting A(1)ARs. Hypoxia treatment did not increase apoptosis, but decreased embryonic cell proliferation. CONCLUSIONS These data indicate that hypoxia adversely influences cardiac malformations during development, in part by A(1)AR signaling.
Collapse
Affiliation(s)
- Satish K Ghatpande
- Section of Developmental Endocrinology and Biology, Yale Child Health Research Center, Department of Pediatrics, Yale University School of Medicine, New Haven, Connecticut 06520, USA.
| | | | | | | |
Collapse
|
21
|
Abstract
Valvular disease may be unmasked in pregnancy when physiological changes increase demands on the heart. Women with valvular heart disease require close follow-up during pregnancy, delivery, and postpartum
Collapse
Affiliation(s)
- E Gelson
- Academic Department of Obstetrics and Gynaecology, Imperial College London, London SW10 9NH.
| | | | | |
Collapse
|