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Tex Heart Inst J ; 27(3): 240-5, 2000.
Artigo em Inglês | MEDLINE | ID: mdl-11093406


In women who have prosthetic heart valves, pregnancy is risky for mother and fetus. Heparin has been considered safer for the fetus than warfarin, but may not provide adequate anticoagulation for the mother. We examined prospectively gathered data from 100 pregnancies in 67 women with mechanical valves (age range, 19 to 45 years). A subgroup of 20 patients was compared with a control group of relatives and neighbors who conceived at similar ages. Fetal loss occurred in 44 of the 100 pregnancies, due to the following causes: spontaneous abortion (28), intrauterine fetal death (4), stillbirth (3), neonatal death (1), premature birth (2), Rh incompatibility (2), and maternal death (4). Age, parity, atrial fibrillation, and left ventricular enlargement did not affect the outcome. Tricuspid valve disease that required diuretics was associated with a higher rate of fetal loss (17 out of 23 pregnancies, versus 27 out of 77; p = 0.001), but did not affect the mother Of 66 pregnancies in which the mother was on heparin, 38 (576%) resulted in a healthy baby, compared with 18 out of 34 (52.9%) pregnancies in which the mother was on warfarin (p = NS). All thromboembolic complications occurred with heparin therapy (9 cases; p = 0.02). In the control group, fetal loss was 24 %, due exclusively to spontaneous abortion. Women with mechanical valves have higher rates of fetal loss and maternal complications. In our study, tricuspid valve disease adversely affected fetal outcome, which is a new finding that warrants further study. Warfarin was more effective than heparin in preventing thromboembolism in the mothers, and it did not show a significant impact on the babies.

Implante de Prótese de Valva Cardíaca , Resultado da Gravidez , Adulto , Anticoagulantes/efeitos adversos , Anticoagulantes/uso terapêutico , Feminino , Morte Fetal/etiologia , Implante de Prótese de Valva Cardíaca/efeitos adversos , Heparina/uso terapêutico , Humanos , Recém-Nascido , Pessoa de Meia-Idade , Paridade , Gravidez , Complicações na Gravidez/etiologia , Complicações Hematológicas na Gravidez/prevenção & controle , Estudos Prospectivos , Tromboembolia/prevenção & controle , Valva Tricúspide/cirurgia , Varfarina/uso terapêutico
Arch Mal Coeur Vaiss ; 91(8): 929-33, 1998 Aug.
Artigo em Francês | MEDLINE | ID: mdl-9749139


BACKGROUND AND OBJECTIVE: Reduced arterial compliance is associated with age, hypertension and left ventricular hypertrophy. It is unclear if and how reduced arterial compliance affects the diastolic properties of the heart. PATIENT POPULATION: We examined 64 normotensive and 27 hypertensive individuals, (31 females, 60 males). Their ages ranged from 19 to 78 years (mean 43 +/- 14.7 y), BP ranged from 80/50 to 180/110 mmHg. Exclusion criteria were atrial fibrillation, coronary or peripheral vascular disease, diabetes, anemia, hypercholesterolaemia, as well as antihypertensive drug therapy. METHODS: Diastolic function was assessed by Doppler measurement of E and A wave velocities of Mitral flow. E acceleration and deceleration slopes and times. LV mass was calculated from an M- mode echocardiogram. Arterial compliance was assessed by an automatic pulse wave velocity (PWV) measurement. RESULTS: Age and PWV correlated significantly with the mitral E and A waves, the E acceleration time. E deceleration and E deceleration time. No significant correlations were found between SBP, DBP or LV mass and the parameters of diastolic function (see table).

Artérias/fisiologia , Diástole , Hipertensão/fisiopatologia , Adulto , Idoso , Velocidade do Fluxo Sanguíneo , Complacência (Medida de Distensibilidade) , Diástole/fisiologia , Ecocardiografia Doppler , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Fluxo Pulsátil , Análise de Regressão