Maternal and fetal outcomes in pregnancy complicated with Eisenmenger syndrome.

OBJECTIVE: The goal of the study was to clarify the risk factors for pregnancy complicated with Eisenmenger syndrome (ES). MATERIALS AND METHODS: A retrospective study was performed in 15 patients with ES who were managed throughout pregnancy at one institution from 1982 to 2013. Cases associated with congenital heart diseases other than atrial septal defect (ASD), ventricular septal defect (VSD), and patent ductus arteriosus (PDA) were excluded. RESULTS: The congenital heart diseases in ES included ASD (n = 3), VSD (n = 9), and PDA (n = 3). Ten women chose termination and 5 continued with their pregnancies. In the 5 continuation cases (PDA 1, VSD 4), worsening of cyanosis, exertional fatigue and dyspnea appeared between 25 and 30 weeks gestation and cesarean section was performed at 30 (28-33) weeks. LVEF, PaO2, and SpO2 decreased and heart rate increased significantly from before pregnancy to 25-30 weeks gestation. From before to during the pregnancy, there were no significant changes in mean PABP or pulmonary vascular resistance (PVR) in four cases with data (582-592, 885 to 868, 1280 to 1291, 1476-1522 dyn × s/cm2). PVR at conception had a negative relationship with delivery weeks. NYHA classes before, during and 1 year after pregnancy were II, III and II. In one recent case, epoprostenol and tadalafil were administered during pregnancy. CONCLUSIONS: Pregnancy with ES has a high risk due to hypooxygenation, cyanosis, and cardiac failure, which can appear as common complications as early as the 2nd trimester. Early interventions with meticulous care are required for these complications during pregnancy and delivery.

Maternal outcome in pregnancy complicated with pulmonary arterial hypertension.

BACKGROUND: Pulmonary arterial hypertension (PAH), including Eisenmenger syndrome, has a risk of mortality in pregnancy of 10-40%. The aim of this study was to investigate whether pulmonary artery blood pressure (PABP) is a prognostic factor for pregnancy outcome in patients with PAH. METHODS AND RESULTS: The subjects were 42 patients with PAH during pregnancy. Severe and mild cases were defined by PABP before and during the first 14 weeks of pregnancy, with severe cases having mean PABP >40 mmHg by catheterization or systolic PABP >50 mmHg on echocardiography. Eighteen women chose termination of pregnancy before 14 weeks, leaving 24 women (10 mild, 14 severe) for analysis. The women with severe PAH delivered earlier (35.4 vs. 31.5 weeks, P<0.05) and had higher rates of small-for-gestational-age infants (0/10 vs. 7/14, P<0.01). Among the women with severe PAH, the New York Heart Association class dropped by 1 in 9 cases, by 2 in 3 cases, and remained the same in 2 cases as pregnancy progressed, whereas among the women with mild PAH, the class dropped by 1 in 1 case and 9 women remained in the same class. Among the severe cases, 1 woman died and there was 1 fetal death; PABP markedly increased in later pregnancy from 54 to 74 mmHg (catheter measurement) and from 78 to 93 mmHg (echocardiography) (P<0.05). CONCLUSIONS: The level of PABP before or in the early stage of pregnancy is an important predictor of pregnancy outcome.

Percutaneous coronary intervention of chronic total occlusion in a left anterior descending coronary artery using an ipsilateral intraseptal bridging collateral tracking technique.

As one of the great breakthrough techniques in the percutaneous coronary intervention (PCI) for the chronic total occlusions of coronary arteries, the controlled antegrade and retrograde subintimal tracking, so called the "CART" technique, has been developed. We present a first case in whom CTO of the mid LAD coronary artery was well-recanalized using the CART technique via the ipsilateral intraseptal bridging collaterals in the PCI.

Significance of serum circulating hepatocyte growth factor in the development of carotid atherosclerosis.

We investigated the relation between the serum concentration of HGF and carotid atherosclerosis. Serum concentrations of HGF were measured in 128 in-patients (mean age, 74 +/- 11 years) free from cardiac, liver and renal diseases, in addition to lung diseases, in the Medical Department of Nomura Municipal Hospital between August, 2000 and June, 2001. Carotid intima-media thickness (IMT) was evaluated by ultrasonography with a 7.5 MHz linear type B-mode probe. The results showed a significantly positive correlation between serum age and HGF concentrations in patients with carotid atherosclerosis (IMT > 1.0 mm) (r = 0.391, p = 0.005). On the other hand, there was no significant correlation between age and serum HGF concentration in those without carotid atherosclerosis (IMT

An association between an antibody against Chlamydia pneumoniae and ischemic stroke in elderly Japanese.

OBJECTIVE: Chlamydia pneumoniae (Cp) is an important pathogen for infections of the respiratory tract; recently, also a number of reports suggesting its relation to atherosclerosis. This study was performed to clarify the relation between Cp infection and ischemic stroke. PATIENTS: Forty elderly patients with ischemic stroke (age 75 +/- 6.6; male 57.5%) and 85 elderly control subjects without a history of ischemic stroke (age 74 +/- 8.1; male 43.5%) were investigated. METHODS: Patients were divided into four groups according to clinical diagnosis: 1) atherothrombotic infarction, 2) lacunar infarction, 3) those with cardiac embolism, and 4) non-classifiable. Cp infection was determined by measuring the anti-Cp IgG specific antibody level (Cp IgG index) using enzyme-linked immunosorbent assay (ELIZA) method. Those below the 1.10 Cp IgG index were determined as seronegative and those above 1.10 as seropositive. RESULTS: We found that 20 cases (87.0%) of atherothrombotic infarction, 6 (66.7%) of lacunar infarction, 3 (50.0%) others and 52 (61.2%) control were Cp seropositive. Cp seropositiveness, as adjusted by multiple regression analysis using various known risk factors, was a significant independent contributing factor for ischemic stroke (p = 0.017) and was associated with an increased risk for atherothrombotic infarction (odds ratio, 12.6; 95% CI, 2.0-79.3). CONCLUSION: This suggests that Cp infection is also an important risk factor for ischemic stroke, particularly atherothrombotic infarction in elderly Japanese.

Association between abdominal wall fat index and carotid atherosclerosis in women.

We tried to investigate whether accumulation of visceral fat assessed by a simple but widely used ultrasonography was associated with common carotid atherosclerosis in women. The subjects were consecutively admitted in-patients whose body mass index was more than 22 kg/m2. Those with cardiorenal or nutritional disorders that would affect blood pressure, and lipid and glucose metabolism were excluded. An ultrasonographic evaluation with a 7.5 MHz linear type B-mode probe was performed by a specialist to determine the intima-media thickness (IMT) of the common carotid artery and maximum thickness of preperitoneal fat (Pmax) at the anterior surface of the liver and the minimum thickness of subcutaneous fat (Smin) of the abdomen. The Pmax/Smin ratio which was termed the abdominal wall fat index (AFI), was then calculated. The subjects were 241 women aged 69 +/- 12 (range, 26-104) years. Multiple regression analysis using the IMT as an object variable, adjusted by various risk factors as explanatory variables showed that AFI [odds ratio, 2.995; 95% confidence interval, 1.106-8.109] was a significant independent contributing factor along with known risk factors such as age, systolic blood pressure, total-cholesterol, and HDL-cholesterol.AFI was useful in evaluating disorders of metabolism, circulation and atherosclerosis.

An association between plasma homocysteine concentrations and ischemic stroke in elderly Japanese.

The present study was performed to clarify the relation between plasma homocysteine and ischemic stroke. We studied the relationship between ischemic stroke and the known risk factors for atherosclerosis including plasma homocysteine in 91 in-patients (80.3 +/- 6.8 years) in a medical ward. Those diagnosed with transient ischemic attack, cerebral infarction were placed in the disease group. Blood was drawn from in-patients in a fasting state for determination of plasma homocysteine. Plasma homocysteine concentrations were determined using a high-performance liquid chromatography assay. The odds ratio of ischemic stroke was higher in the second (10.0-13.9 micromol/l) and third highest plasma homocysteine concentration groups (> or = 14.0 micromol/l) than in the first group (< 10.0 micromol/l) by 5.18 and 4.42-fold, respectively. Logistic regression analysis using ischemic stroke as an object variable, adjusted by various risk factors including the plasma homocysteine concentration showed that the odds ratio on combining the second and third groups was 5.80 (95% confidence interval (Cl): 1.50-22.5) compared with the first group. The findings confirmed that the association between plasma homocysteine concentration and ischemic stroke in Western populations is also present among the elderly Japanese.