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Elkayam U, Bansal P, Mehra A. Catheter-Based Interventions for the Management of Valvular Heart Disease During Pregnancy. JACC. ADVANCES 2022; 1:100022. [PMID: 38939308 PMCID: PMC11198064 DOI: 10.1016/j.jacadv.2022.100022] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Revised: 03/01/2022] [Accepted: 03/09/2022] [Indexed: 06/29/2024]
Abstract
Pregnancy is associated with a significant increase in hemodynamic burden. These changes can lead to maternal morbidity and mortality as well as unfavorable fetal outcomes in patients with valvular heart disease and limited cardiac reserve. Mechanical interventions may be needed for the management of severe hemodynamic deterioration not responding to medical therapy. Catheter-based percutaneous interventions can provide an alternative therapy to surgery during pregnancy. The purpose of this article is to review indications, potential advantages, and limitations of catheter-based interventions for the management of women with valvular heart disease in pregnancy.
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Affiliation(s)
- Uri Elkayam
- Division of Cardiology, Department of Medicine, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
- Department of Obstetrics and Gynecology, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
| | - Priya Bansal
- Division of Cardiology, Department of Medicine, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
| | - Anil Mehra
- Division of Cardiology, Department of Medicine, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
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2
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Rasmussen K, Rokey R, Rolak SC, Zhong C, Braxton JH, Hashimoto K. Repeat Pregnancy after Prior Aortic Valve-in-Valve Replacement: A Cautionary Tale. Clin Med Res 2020; 18:153-160. [PMID: 32878905 PMCID: PMC7735452 DOI: 10.3121/cmr.2020.1554] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2020] [Revised: 06/02/2020] [Accepted: 06/23/2020] [Indexed: 11/18/2022]
Abstract
Transcatheter aortic valve replacement (TAVR) within a severely stenotic native aortic valve or previously placed surgical biologic aortic valve replacement (SAVR) is a rare occurrence in pregnant patients. The short- and long-term procedural outcomes for future pregnancies in these women or any woman of child bearing age who have received prior TAVR or TAVR in SAVR, are unknown. We describe the first result of a repeat pregnancy outcome in a woman with a history of prior TAVR in SAVR. Both maternal and fetal outcomes were favorable, but maternal cardiac complications observed in the third trimester emphasize our concerns regarding risk for cardiac complications in subsequent pregnancies in patients with a prior TAVR in SAVR. Despite the maternal complications that occurred during repeat pregnancy in this patient, a successful pregnancy outcome reaffirms our recommendation to utilize a multidisciplinary team for pregnancy management in patients with prior TAVR or TAVR in SAVR and to help in the management of any cardiac complications that may occur during or shortly after pregnancy.
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Affiliation(s)
- Kelly Rasmussen
- Cardiology Department, Marshfield Medical Center, Marshfield, WI USA
| | - Roxann Rokey
- Clinical Research Center, Marshfield Clinic Research Institute, Marshfield, WI USA
| | - Stacey C Rolak
- University of Wisconsin, School of Medicine and Public Health, Madison, WI USA
| | - Chuyang Zhong
- Department of Internal Medicine, Marshfield Medical Center, Marshfield, WI USA
| | - John H Braxton
- Department of Surgery, Billings Clinic, Billings, MT USA
| | - Kazumasa Hashimoto
- Obstetrics and Gynecology Department, Marshfield Medical Center, Marshfield, WI USA
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3
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Zhong C, Rokey R, Rolak S, Mesa J. Pregnancy and transcatheter aortic valve replacement in a severely stenotic Freestyle full aortic root stentless bioprosthesis. Catheter Cardiovasc Interv 2019; 95:1225-1229. [PMID: 31483554 DOI: 10.1002/ccd.28481] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2019] [Revised: 07/26/2019] [Accepted: 08/20/2019] [Indexed: 12/22/2022]
Abstract
Symptomatic degenerative prosthetic aortic valve stenosis during pregnancy represents a significant risk to both mother and fetus, and until recently, surgical aortic valve replacement (SAVR) during pregnancy was often the only choice for women opting to continue pregnancy. However, symptomatic severe stenosis in a pregnant woman with a degenerated full aortic root Freestyle stentless bioprosthesis (FSB) and reimplanted coronary arteries presents additional complexities that require an alternative surgical approach. In this case report, we describe the first successful transcatheter aortic valve replacement (TAVR) in SAVR for a severely stenotic degenerative FSB in a pregnant woman and subsequent delivery of a healthy infant several months later. TAVR in SAVR of a severely stenotic aortic FSB should be considered as a surgical option in symptomatic pregnant women. Short-term and long-term implications for future pregnancy should be discussed by a multidisciplinary team and with the patient.
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Affiliation(s)
- Chuyang Zhong
- Department of Internal Medicine, Marshfield Medical Center-Marshfield, Marshfield, Wisconsin
| | - Roxann Rokey
- Clinical Research Center, Marshfield Clinic Research Institute, Marshfield, Wisconsin
| | - Stacey Rolak
- University of Wisconsin, School of Medicine and Public Health, Madison, Wisconsin
| | - Juan Mesa
- Cardiology Department, Marshfield Medical Center-Marshfield, Marshfield, Wisconsin
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Herbert KA, Sheppard SM. Not Your Typical Dyspnea of Pregnancy: A Case Report of Transcatheter Valve-in-Valve Replacement During Pregnancy. A A Pract 2019; 12:202-204. [DOI: 10.1213/xaa.0000000000000884] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
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Chengode S, Shabadi RV, Rao RN, Alkemyani N, Alsabti H. Perioperative management of transcatheter, aortic and mitral, double valve-in-valve implantation during pregnancy through left ventricular apical approach. Ann Card Anaesth 2018; 21:185-188. [PMID: 29652282 PMCID: PMC5914221 DOI: 10.4103/aca.aca_157_17] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Pregnant women with stenotic degeneration of bioprosthetic cardiac valves may require another valve replacement procedure when their symptoms deteriorate with progression of pregnancy, but fetal mortality is higher with cardiac surgery done on cardiopulmonary bypass. Transcatheter valve-in-valve implantation may help to improve the fetal and maternal outcomes in these situations. Double valve-in-valve implantation is rare and has not been reported in a pregnant patient. We report, for the first time, the case of a pregnant woman with stenotic bioprosthetic valves in the mitral and aortic positions, who underwent a successful concomitant, transcatheter, double valve-in-valve implantation through the left ventricular apical route during the second trimester of her precious pregnancy.
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Affiliation(s)
- Suresh Chengode
- Department of Anaesthesia, Division of Cardiac Anaesthesia, Sultan Qaboos University Hospital, Muscat, Oman
| | - Rahul Vijaykumar Shabadi
- Department of Anaesthesia, Division of Cardiac Anaesthesia, Sultan Qaboos University Hospital, Muscat, Oman
| | - Ram Narayan Rao
- Department of Anaesthesia, Division of Cardiac Anaesthesia, Sultan Qaboos University Hospital, Muscat, Oman
| | - Nasser Alkemyani
- Department of Anaesthesia, Division of Cardiac Anaesthesia, Sultan Qaboos University Hospital, Muscat, Oman
| | - Hilal Alsabti
- Department of Surgery, Division of Cardiac Surgery, Sultan Qaboos University Hospital, Muscat, Oman
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Wajih Ullah M, Lakhani S, Sham S, Ashraf F, Siddiq W, Siddiqui T. Subacute Infective Endocarditis of Aortic Valve During Pregnancy. Cureus 2018; 10:e2748. [PMID: 30087824 PMCID: PMC6075646 DOI: 10.7759/cureus.2748] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Bacterial infective endocarditis is a rare but a life-threatening infection during pregnancy. Infective endocarditis during pregnancy is often associated with a congenital heart condition or an earlier history of rheumatic heart disease. In pregnant women with infective endocarditis, the maternal and fetal mortality rate can reach as high as 33% and 29%, respectively. In most cases, infective endocarditis runs a subacute course and involves the mitral valve, nonetheless, rarely it can involve the aortic valve as well. We are documenting a rare case of subacute infective endocarditis in a 26-year-old pregnant female with severe aortic stenosis with associated multiple systemic emboli. The patient was managed by urgent cesarean section at 35 weeks of gestation followed by aortic valve replacement; there was no maternal or fetal mortality. This case report highlights the importance of early diagnosis, and timely management of infective endocarditis in pregnant women to prevent maternal and fetal death.
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Affiliation(s)
| | - Sunita Lakhani
- Internal Medicine, Liaquat University of Medical and Health Sciences Hospital Jamshoro Sindh Pakistan., Jamshoro, PAK
| | - Sunder Sham
- Internal Medicine, Ghulam Muhammad Mahar Medical College, Sukkur, PAK
| | - Fariha Ashraf
- Cardiology, VA Palo Alto Health Care System, Palo Alto, USA
| | - Wardah Siddiq
- Internal Medicine, Beth Israel Deaconess Medical Center/ Harvard Medical College, Boston, USA
| | - Tariq Siddiqui
- Internal Medicine, Maharashtra Institute of Medical Education & Research, Talegaon, IND
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Abstract
Patients with inoperable, high-risk, and intermediate-risk aortic stenosis can now be treated with transcatheter aortic valve replacement. Centers for Medicare and Medicaid Services and the Food and Drug Administration selectively choose centers based on experience and require a collaborative, multidisciplinary team approach in the treatment and decision making for these patients. The work-up has been streamlined. Gated multislice computed tomography angiogram has emerged as the gold standard for assessment of valve anatomy and sizing of the transcatheter heart valve. Assessment of risk has evolved to include a more comprehensive functional and frailty evaluation. Long term-results are needed before the expansion of transcatheter aortic valve replacement into the low-risk category.
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Affiliation(s)
- John H Braxton
- Structural Heart Services, Marshfield Clinic, Saint Joseph Hospital, 1000 North Oak Avenue, Section 2C2, Marshfield, WI 54449, USA.
| | - Kelly S Rasmussen
- Structural Heart Services, Department of Cardiology, Marshfield Clinic, Saint Joseph Hospital, 1000 North Oak Avenue, Section 2C2, Marshfield, WI 54449, USA
| | - Milind S Shah
- Structural Heart Services, Section of Cardiology, Marshfield Clinic, Saint Joseph Hospital, 1000 North Oak Avenue, Section 2C2, Marshfield, WI 54449, USA
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