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1.
J Perinat Med ; 2020 Apr 09.
Artigo em Inglês | MEDLINE | ID: mdl-32284451

RESUMO

Background There are numerous significant physiological changes occurring in circulation during labor. To detect these rapid hemodynamic changes, invasive and intermittent measurement techniques are not reliable. To suggest a suitable delivery method for pregnancy with cardiac disease, this study analyzed how each delivery method influences cardiac function using a noninvasive and continuous measurement technique. Methods A prospective study was accomplished at the National Cerebral and Cardiovascular Center in Japan from October 1, 2014, to November 30, 2018. The classification of the healthy heart pregnant women was according to the delivery method: vaginal delivery (VD) without epidural anesthesia, VD with epidural anesthesia, and caesarean section (CS). The hemodynamic parameters cardiac index (CI), stroke volume index (SI), and heart rate (HR) were evaluated regularly throughout delivery by noninvasive electrical cardiometry monitor. Results Ten cases were examined for each group. CI and HR were significantly increased before VD, while the increase in CI and HR was mild in the epidural group in comparison to the nonepidural group. SI was increased toward the delivery in the epidural group, and it was constant in the nonepidural group. However, there was no alteration in the level of outcomes of the two groups. In CS, SI increased and HR decreased before delivery. After delivery, SI continued to increase, while HR did not change but CI increased. Conclusion In VD, the increase in venous circulation according to the autotransfusion is managed by increasing HR. By epidural anesthesia, the increase in HR was suppressed and SI was increased. However, as epidural anesthesia increases the vascular capacity, the level of SI outcome was comparable. In CS, the HR was decreased because of the spinal anesthesia and the SI was increased because of many factors like hydration. As there are many factors to control in CS, VD with epidural anesthesia will be the first preference for most cardiac patients.

3.
Pediatr Cardiol ; 40(6): 1134-1143, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31087143

RESUMO

The effect of pregnancy on aortic root in women with repaired conotruncal anomalies (CTA) has not been clarified. This study examined aortic diameters during and after pregnancy in women with repaired CTA. A retrospective review of consecutive pregnant women with repaired CTA was performed for results of echocardiography from 1 year before pregnancy to 3 years after delivery and compared with findings from healthy pregnant volunteers. Participants comprised 42 subjects and 49 deliveries with repaired CTA (CTA group), and 47 healthy pregnant women (control group). Although no maternal aortic events were encountered, aortic diameters during pregnancy increased by 1.0 ± 2.2 mm (maximum, 7.0 mm) in the CTA group and 0.6 ± 1.3 mm (maximum, 3.4 mm) in the control group (p = 0.13). The CTA subgroup with increase in aortic diameter ≥ 3.5 mm during pregnancy showed no reversion to baseline diameter at follow-up > 6 months after delivery. Significant risk factors for increased aortic diameter and no reversal included pulmonary atresia, history of aortopulmonary shunt, older age at repair, and smaller left ventricular end-diastolic diameter pre-pregnancy. Women with repaired CTA tolerated pregnancy and delivery well. However, the aortic root progressively dilated during pregnancy and 1/4 of them, especially those with longstanding high aortic blood flow before repair, showed an increase of aortic root size of ≥ 3.5 mm during the peripartum period; this dilatation tended not to revert to the pre-pregnancy diameter. Therefore, serial measurement of the aortic root during pregnancy and after delivery is recommended in these women.


Assuntos
Aorta/patologia , Valva Aórtica/patologia , Seio Aórtico/patologia , Adulto , Fatores Etários , Aorta/anormalidades , Aorta/diagnóstico por imagem , Valva Aórtica/anormalidades , Valva Aórtica/diagnóstico por imagem , Estudos de Casos e Controles , Angiografia por Tomografia Computadorizada , Parto Obstétrico/efeitos adversos , Dilatação Patológica/etiologia , Ecocardiografia , Feminino , Cardiopatias Congênitas/cirurgia , Humanos , Imageamento Tridimensional , Imagem por Ressonância Magnética , Masculino , Gravidez , Atresia Pulmonar/etiologia , Estudos Retrospectivos , Fatores de Risco , Seio Aórtico/diagnóstico por imagem , Fatores de Tempo
4.
J Cardiol ; 74(4): 347-352, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31060956

RESUMO

BACKGROUND: Women with complete atrioventricular block (CAVB) can tolerate hemodynamic changes during pregnancy; however, the incidence of cardiac events in women with CAVB may increase after delivery. The aim of this study was to investigate predictive factors for postpartum cardiac events in pregnant women with CAVB. METHODS AND RESULTS: Pregnant women with CAVB who received perinatal management at a tertiary cardiac center from 1981 to 2015 were retrospectively reviewed. Univariate and multivariate logistic analyses of postpartum cardiac events were performed. Postpartum cardiac event was defined as cardiopulmonary arrest, cardiac failure, or the need for permanent pacemaker implantation (p-PMI) within 3 months after delivery. A total of 63 pregnancies in 36 women with CAVB were included in this study; 25 had undergone p-PMI before pregnancy. Regardless of p-PMI status, women with CAVB had no further increases in heart rate during the second and third trimesters. No heart failure was found during pregnancy and delivery. Postpartum cardiac events occurred in 9 pregnancies (14.3%) in 8 women with CAVB; 3 had cardiac failure and p-PMI, 3 had cardiac failure, 2 required p-PMI, and 1 had cardiopulmonary arrest. Multivariate analysis showed that perinatal ventricular pause (odds ratio 11.60, 95% confidence interval 1.90-82.18, p<0.01) and family history of CAVB (odds ratio 10.59, 95% confidence interval 1.36-90.56, p=0.03) were associated with postpartum cardiac events. CONCLUSIONS: All cardiac events occurred during the postpartum period among women with CAVB, and ventricular pause during the perinatal period and a family history of CAVB were predictors of postpartum cardiac events. Close follow-up should be considered during the postpartum period for women with high-risk CAVB.

5.
Taiwan J Obstet Gynecol ; 58(2): 183-187, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-30910135

RESUMO

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.


Assuntos
Complexo de Eisenmenger/terapia , Insuficiência Cardíaca/terapia , Complicações Cardiovasculares na Gravidez/terapia , Gravidez de Alto Risco , Aborto Espontâneo , Aborto Terapêutico , Adulto , Cateterismo Cardíaco , Cesárea , Permeabilidade do Canal Arterial/complicações , Ecocardiografia , Complexo de Eisenmenger/complicações , Feminino , Insuficiência Cardíaca/complicações , Comunicação Interatrial/complicações , Comunicação Interventricular/complicações , Humanos , Gravidez , Estudos Retrospectivos , Fatores de Risco
6.
Pediatr Cardiol ; 40(4): 865-870, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30830281

RESUMO

The frequency of newborns with congenital heart disease (CHD) is approximately 1% in the general population; however, the recurrence rate of CHD in mothers with CHD differs in ethnicity and reports. We therefore aimed to determine the prevalence of CHD among neonates born to mothers with CHD in our institute in Japan. We reviewed the medical charts of 803 neonates delivered by 529 women with CHD at the National Cerebral and Cardiovascular Center from 1982 to 2016. They included isolated ventricular septal defect (VSD,31.4%), isolated atrial septal defect (ASD, 23.3%), tetralogy of Fallot (TOF,10.6%). We defined CHD in neonates as being diagnosed within 1 month of birth. We estimated that the average rate of the CHD recurrence was 3.1%. The recurrence ratios in each maternal CHD were 8.6%, 7.1%, 6.2%, 4.8%, 3.6%, and 1.5% for PS, CoA, TOF, atrioventricular septal defect, VSD, and ASD, respectively. The rate of CHD in offsprings whose mothers have CHD was 3 times greater than that of mothers with healthy hearts. Almost half of neonates with CHD had the same phenotype as their mother in our series. Especially, PS and CoA were closely related to the type of maternal CHD.


Assuntos
Cardiopatias Congênitas/epidemiologia , Adolescente , Adulto , Criança , Feminino , Cardiopatias Congênitas/etiologia , Humanos , Recém-Nascido , Japão , Masculino , Pessoa de Meia-Idade , Mães/estatística & dados numéricos , Prevalência , Recidiva , Estudos Retrospectivos , Adulto Jovem
7.
J Obstet Gynaecol Res ; 45(2): 382-388, 2019 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-30259601

RESUMO

AIM: We sought to examine the safety and efficacy of a 52-mg levonorgestrel-releasing intrauterine system (LNG-IUS), and to evaluate the changes in biomarkers of infection, anemia and cardiovascular conditions after LNG-IUS insertion in women with cardiovascular disease. METHODS: We prospectively followed women with a cardiovascular disease in whom a 52-mg LNG-IUS was inserted between 2009 and 2015. The primary outcome was the frequency of cardiovascular and gynecologic side effects due to the LNG-IUS over the year after LNG-IUS insertion. The secondary outcomes were the changes in menstrual blood loss and biomarkers, e.g., white blood cell count and the levels of C-reactive protein, hemoglobin and brain natriuretic peptide. We also evaluated the 24-month continuation rate of LNG-IUS. RESULTS: A total of 34 women were prospectively followed-up, including two women with pulmonary hypertension. No cardiovascular side effects were identified during the 1 year after LNG-IUS insertion, other than one case of mild vasovagal reaction at insertion. Neither the white blood cell count nor the C-reactive protein value increased after LNG-IUS insertion. The menstrual blood loss was decreased in most subjects and the median hemoglobin levels increased significantly within 1 year after insertion (P < 0.001 and P = 0.002). Moreover, brain natriuretic peptide levels tended to decrease in correspondence with the hemoglobin elevation (P = 0.074). The 24-month LNG-IUS continuation rate was 97% (95% confidence interval 85-100). CONCLUSION: No clinically significant cardiovascular event was identified during the 1 year after 52-mg LNG-IUS insertion among women with cardiovascular disease. The 52-mg LNG-IUS may have specific favorable effects by decreasing the risk of iron deficiency anemia in these women.


Assuntos
Doenças Cardiovasculares/sangue , Anticoncepcionais Femininos/farmacologia , Dispositivos Intrauterinos Medicados , Levanogestrel/farmacologia , Adulto , Doenças Cardiovasculares/induzido quimicamente , Anticoncepcionais Femininos/administração & dosagem , Anticoncepcionais Femininos/efeitos adversos , Feminino , Seguimentos , Humanos , Dispositivos Intrauterinos Medicados/efeitos adversos , Levanogestrel/administração & dosagem , Levanogestrel/efeitos adversos
8.
J Cardiol ; 73(3): 247-254, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-30579805

RESUMO

OBJECTIVE: Arterial switch operation (ASO) for dextro-transposition of the great arteries (d-TGA) has gradually replaced the atrial switch operation and has become the standard operation. To date, the outcomes of pregnant women with d-TGA after this new operation have not been investigated. In this study, we investigated the impact of ASO on pregnant outcomes and mid-term prognosis in women with d-TGA and compared with the atrial switch operation through the literature review. METHODS AND RESULTS: There were 20 pregnancies in 10 women with d-TGA after ASO and 6 resulted in abortion. Among 14 successful pregnancies in 10 women, 11 pregnancies achieved the term delivery and 3 pregnancies, including 1 twin pregnancy, resulted in preterm labor. Maternal cardiovascular events occurred in 4 (heart failure and arrhythmias in 3 and arrhythmia in 1), and all were controllable with medications. Risk factors for the peripartum cardiac events were older age at ASO and delivery, and higher concentration of brain natriuretic peptide (BNP) at first trimester (p<0.05). In 7-60 month-follow-up after delivery, no case showed deterioration of functional class and systemic ventricular function. According to the literature review, women after ASO demonstrated a better prognosis than those after the atrial switch operation. CONCLUSIONS: The majority of women with d-TGA after ASO tolerated pregnancy and delivery well. The older age at ASO, an elderly pregnancy, and higher BNP levels at the first trimester were possibly risk factors of peripartum cardiovascular events among the group. The literature reviews and this study may indicate the advantage of systemic left ventricle compared with systemic right ventricle in long-term outcomes after delivery.

9.
Int Heart J ; 59(4): 862-867, 2018 Jul 31.
Artigo em Inglês | MEDLINE | ID: mdl-29794382

RESUMO

Little is known about pregnancies of left ventricular noncompaction cardiomyopathy (LVNC), much less cases in which LVNC was definitively diagnosed prepregnancy. We report the cases of three pregnant Japanese women definitively diagnosed with LVNC prepregnancy. Case 1 presented LVNC with restrictive phenotype. Her pregnancy was terminated due to exacerbated pulmonary hypertension and low output status at 30 weeks' gestation. Case 2 presented isolated LVNC with nonsustained ventricle tachycardia. A cesarean section was performed at 36 weeks' gestation because of placenta previa. Case 3 presented dilated LVNC. Labor induction was performed because of decreased left ventricular ejection fraction, leading to a vaginal delivery at 37 weeks' gestation. In all cases, no thromboembolic event was identified during pregnancy; two patients received anticoagulants. We reviewed all English-literature cases of pregnant women definitively diagnosed with LVNC prepregnancy to analyze causes of adverse pregnancy outcomes and the necessity of anticoagulation. Four of the six pregnancies identified were terminated due to exacerbated cardiomyopathy phenotypes and not complications due to noncompaction itself, resulting in three cases' preterm deliveries. No thromboembolic event was identified by maintenance of the anticoagulation strategy determined prepregnancy. In pregnancies with LVNC, the possibility of a severe cardiac event and the indications for termination of the pregnancy can depend on the cardiomyopathy phenotypes, not noncompaction itself. Anticoagulation only because of the pregnancy itself may be redundant. In the management of LVNC during pregnancy, close monitoring of the condition of different phenotypes and reassessment of the necessity of anticoagulation can contribute to the pregnancy outcome.


Assuntos
Anticoagulantes/administração & dosagem , Miocárdio Ventricular não Compactado Isolado , Complicações Cardiovasculares na Gravidez , Tromboembolia/prevenção & controle , Adulto , Cesárea/métodos , Feminino , Humanos , Hipertensão Pulmonar/diagnóstico , Hipertensão Pulmonar/etiologia , Miocárdio Ventricular não Compactado Isolado/complicações , Miocárdio Ventricular não Compactado Isolado/diagnóstico , Miocárdio Ventricular não Compactado Isolado/fisiopatologia , Trabalho de Parto Induzido/métodos , Administração dos Cuidados ao Paciente/métodos , Gravidez , Complicações Cardiovasculares na Gravidez/diagnóstico , Complicações Cardiovasculares na Gravidez/fisiopatologia , Complicações Cardiovasculares na Gravidez/terapia , Resultado da Gravidez , Taquicardia Ventricular/diagnóstico , Taquicardia Ventricular/etiologia , Tromboembolia/etiologia , Disfunção Ventricular Esquerda/diagnóstico , Disfunção Ventricular Esquerda/etiologia
10.
Int Heart J ; 59(2): 435-438, 2018 Mar 30.
Artigo em Inglês | MEDLINE | ID: mdl-29445057

RESUMO

Recently, implantable cardioverter-defibrillators (ICD) have become capable of monitoring intrathoracic impedance to detect an increased fluid volume and heart failure. Pregnancy is a well-known cause of an increased body fluid volume; however, it is not clear whether the measurement of intrathoracic impedance by ICD is clinically useful for precisely detecting heart failure in pregnant women. We herein report the case of a 39-year-old woman with an ICD that had been implanted after an event of ventricular fibrillation due to severe aortic regurgitation with a bicuspid aortic valve. Elevated right ventricular pressure and brain natriuretic peptide levels were detected at 37 weeks of gestation and postpartum. At the same time, the ICD's stored fluid index gradually increased and exceeded the threshold on the 10th day after delivery. She was treated with diuretics and recovered from postpartum heart failure. The physiological volume changed in the perinatal period, but we were still able to detect heart failure by ICD. Intrathoracic impedance monitoring is effective in the perinatal field.


Assuntos
Desfibriladores Implantáveis , Impedância Elétrica , Insuficiência Cardíaca/diagnóstico , Complicações Cardiovasculares na Gravidez/diagnóstico , Fibrilação Ventricular/terapia , Adulto , Feminino , Humanos , Período Periparto , Gravidez , Equilíbrio Hidroeletrolítico/fisiologia
11.
Pregnancy Hypertens ; 10: 46-50, 2017 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-29153689

RESUMO

OBJECTIVES: Pregnancy can be well tolerated after the repair of aortic coarctation. However, a higher incidence of hypertensive disorders during these pregnancies was reported. We analyzed the perinatal changes in echocardiographic parameters in women with aortic coarctation and investigated the risk factors of gestational hypertension (GH). METHODS: We retrospectively identified 15 pregnancies in nine Japanese women with aortic coarctation between 1982 and 2015. We categorized the patients according to the presence/absence of GH as the group with GH(n=3) and that without GH(n=12). The echocardiographic parameters were compared between groups. RESULTS: Our analysis revealed that a pre-pregnancy Doppler-measured pressure gradient≥20mmHg and a left ventricular mass index≥95g/m2 were significant risk factors for GH. The left ventricular end-diastolic diameters at the first and the third trimesters, the left ventricular end-systolic diameters at the first trimester, and the left ventricular ejection fraction at the third trimester were also significantly higher in the pregnancies with GH. All of these findings had been obtained before the patients' GH occurred. CONCLUSIONS: Hypertrophy of the left ventricle with a lower ejection fraction and a high pressure gradient across the coarctation were risk factors for GH in the patients with aortic coarctation. Thus, serial measurements using echocardiography are important for predicting GH in women with aortic coarctation. However, further research investigating this finding with a larger sample size is needed.


Assuntos
Coartação Aórtica , Hipertensão Induzida pela Gravidez/diagnóstico , Complicações Cardiovasculares na Gravidez , Ultrassonografia Pré-Natal , Adulto , Ecocardiografia Doppler , Feminino , Humanos , Hipertensão Induzida pela Gravidez/diagnóstico por imagem , Hipertensão Induzida pela Gravidez/fisiopatologia , Pré-Eclâmpsia/diagnóstico , Pré-Eclâmpsia/diagnóstico por imagem , Pré-Eclâmpsia/fisiopatologia , Gravidez , Primeiro Trimestre da Gravidez
12.
J Obstet Gynaecol Res ; 43(10): 1629-1633, 2017 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-28691228

RESUMO

Pregnancy with Marfan syndrome (MFS) presents challenges to the clinician because of the increased incidence of maternal cardiovascular complications, including acute aortic dissection (ADD) and the involvement of the fetus owing to the urgency of the need for surgery and the low likelihood of survival with premature delivery. Patient 1 was a 36-year-old pregnant Japanese woman with MFS who was referred at 16 gestational weeks with aortic root diameter 35.1 mm. Stanford type B AAD occurred on delivery without evident blood pressure changes. Patient 2 was a 31-year-old pregnant Japanese woman with MFS with aortic root diameter 28.3 mm at 20 gestational weeks after David procedure. Ultimately fatal Stanford type B AAD occurred on post-partum day 15. Both patients were treated with beta-blockers when AAD occurred. Although these two patients were initially considered to have relatively low risk according to previous reports and guidelines, AAD occurred. It is very important to provide information about these high pregnancy risks to women with MFS before conception, and to follow MFS pregnancies with great caution.


Assuntos
Antagonistas Adrenérgicos beta/farmacologia , Aneurisma Dissecante , Aneurisma Aórtico , Síndrome de Marfan/complicações , Complicações Cardiovasculares na Gravidez , Adulto , Aneurisma Dissecante/tratamento farmacológico , Aneurisma Dissecante/etiologia , Aneurisma Aórtico/tratamento farmacológico , Aneurisma Aórtico/etiologia , Feminino , Humanos , Gravidez , Complicações Cardiovasculares na Gravidez/tratamento farmacológico , Complicações Cardiovasculares na Gravidez/etiologia
13.
Med Mycol J ; 55(1): E1-7, 2014.
Artigo em Inglês | MEDLINE | ID: mdl-24682093

RESUMO

Species distribution and antifungal susceptibility of Candida isolates at one institution were evaluated. Detection rates of fungi were examined for 5 years between 2007 and 2011. Sensitivities of fungi to amphotericin B, flucytosine, fluconazole, micafungin, itraconazole, and voriconazole were evaluated in blood culture-positive patients. A total of 3,832 fungal isolates were detected, including Candida albicans 66.5%, Candida glabrata 20.3%, Candida parapsilosis 6.2%, Candida tropicalis 5.5%, and others 1.5%. Candidemia was diagnosed in 131 patients, and C. albicans, C. parapsilosis, C. glabrata, C. tropicalis, and others were present in 42.0%, 27.5%, 16.0%, 8.4%, and 6.1% of these patients, respectively. Voriconazole had the lowest MIC90s against C. albicans and C. parapsilosis (0.015 and 0.25). Micafungin had a low MIC90 against C. glabrata and C. tropicalis. C. albicans was the most common fungus in patients with candidemia. Voriconazole and micafungin were effective against C. albicans. Amphotericin B was effective for C. parapsilosis, and micafungin showed good efficacy against C. glabrata and C. tropicalis.


Assuntos
Anfotericina B/farmacologia , Antifúngicos/farmacologia , Candida/efeitos dos fármacos , Candida/isolamento & purificação , Candidemia/microbiologia , Equinocandinas/farmacologia , Fluconazol/farmacologia , Flucitosina/farmacologia , Itraconazol/farmacologia , Lipopeptídeos/farmacologia , Voriconazol/farmacologia , Candida albicans/efeitos dos fármacos , Candida albicans/isolamento & purificação , Candida glabrata/efeitos dos fármacos , Candida glabrata/isolamento & purificação , Candida tropicalis/efeitos dos fármacos , Candida tropicalis/isolamento & purificação , Farmacorresistência Fúngica , Instalações de Saúde , Humanos , Japão , Micafungina , Fatores de Tempo
14.
Am J Obstet Gynecol ; 209(5): 452.e1-6, 2013 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-23860210

RESUMO

OBJECTIVE: The goal of the study was to examine risks in pregnancy in patients with Ebstein anomaly. STUDY DESIGN: Data were examined retrospectively for 13 patients (27 pregnancies, 21 live births) with Ebstein anomaly during pregnancy who were treated at our institution from 1985 to 2011. The associated anomalies in these patients were atrial septal defect (ASD) (n = 4) and the Wolff-Parkinson-White syndrome (n = 6). RESULTS: Before pregnancy, 2 patients underwent ASD closure and 1 received tricuspid valve replacement (TVR). In all patients, the cardiothoracic ratio increased from 55.1 at conception to 57.0 during pregnancy and 58.0 postpartum (P < .05). Cesarean sections were performed in 3 cases: 1 with ventricular tachycardia and orthopnea (New York Heart Association [NYHA] III) preterm; at full term, and the third in a patient with a mechanical tricuspid valve who developed maternal cerebellum hemorrhage at 27 weeks. The baby died of prematurity in the third case. In all other cases (20 of 21), neonatal prognoses were good without congenital heart diseases. There were 6 spontaneous abortions. Recurrent paroxysmal supraventricular tachycardia occurred during pregnancy in 2 cases and was treated with adenosine triphosphate or verapamil. In 17 pregnancies, NYHA remained in class I and all had full-term vaginal delivery. CONCLUSION: Maternal and fetal outcomes are good in patients with Ebstein anomaly and NYHA class I. However, pregnancy in Ebstein anomaly can be complicated with tachyarrhythmia or cardiac failure. In post-TVR cases, meticulous care is required for these complications during pregnancy and delivery.


Assuntos
Anomalia de Ebstein/complicações , Comunicação Interatrial/complicações , Complicações Cardiovasculares na Gravidez , Resultado da Gravidez , Síndrome de Wolff-Parkinson-White/complicações , Aborto Espontâneo , Adulto , Cesárea , Estudos de Coortes , Feminino , Comunicação Interatrial/cirurgia , Humanos , Gravidez , Nascimento Prematuro , Estudos Retrospectivos , Fatores de Risco , Resultado do Tratamento , Valva Tricúspide/cirurgia , Síndrome de Wolff-Parkinson-White/terapia
15.
Fetal Diagn Ther ; 34(1): 19-25, 2013.
Artigo em Inglês | MEDLINE | ID: mdl-23595018

RESUMO

OBJECTIVE: From a single-center retrospective cohort with fetal chylothorax, we evaluated the factors related to the decision to use shunting, poor prognostic factors, and reported shunting outcomes with a new double basket-catheter device. METHODS: A retrospective single-center study was performed in 35 cases of fetal chylothorax. RESULTS: There were 35 cases of chylothorax: 23 with hydrops and 12 without hydrops. Twenty-one procedures were performed on 15 fetuses (11 with hydrops) with a single shunt in 11, two shunts in 3 and four shunts in 1. All 12 nonhydropic cases survived. In 23 hydropic cases, overall survival rates with and without thoracoamniotic shunting were 46 and 33%, respectively. The mortality rates of fetal hydropic cases with and without ascites were 93 and 11%, respectively. Fetal ascites, progression of fetal hydrops, and premature delivery at <33 weeks were significant risk factors for a poor prognosis. Progression of polyhydramnios after shunting was also associated with a poor prognosis. Obstruction of the catheter was observed in 38%. There were no direct fetal deaths associated with shunting. CONCLUSION: Thoracoamniotic shunting should be considered for pleural effusion before development of fetal hydrops, or at least before the appearance of fetal ascites. A double-basket catheter tends to be obstructive, but may be less invasive for fetuses.


Assuntos
Quilotórax/cirurgia , Terapias Fetais/instrumentação , Hidropisia Fetal/cirurgia , Derrame Pleural/cirurgia , Adulto , Cateterismo , Quilotórax/complicações , Feminino , Morte Fetal , Humanos , Hidropisia Fetal/etiologia , Hidropisia Fetal/prevenção & controle , Gravidez , Estudos Retrospectivos , Fatores de Risco , Adulto Jovem
16.
Circ J ; 77(5): 1166-70, 2013.
Artigo em Inglês | MEDLINE | ID: mdl-23291990

RESUMO

BACKGROUND: There are few studies of pregnancy and delivery in patients with an implantable cardioverter-defibrillator (ICD). The purpose of this study was to investigate maternal and fetal outcome in these patients. METHODS AND RESULTS: Six pregnant women with an ICD were retrospectively reviewed. All women underwent implantation of an ICD before pregnancy and delivered at the National Cerebral and Cardiovascular Center. The mean age at pregnancy and the mean follow-up period after ICD implantation were 28±3 years old and 5±3 years, respectively. There was no device-related complication during pregnancy. In 4 women, the number of tachyarrhythmias such as non-sustained ventricular tachycardia increased after the end of the second trimester of pregnancy and anti-arrhythmic medications were gradually increased. No patient received discharges or shocks from the ICD during pregnancy, however, and only one required anti-tachycardia pacing at 27 weeks' gestation. Mean gestational age at delivery was 37±2 weeks and all deliveries were by cesarean section, including 5 as emergency deliveries due to a fetal indication. After delivery, 2 mothers had reduced cardiac function and 1 received an ICD shock for the first time. CONCLUSIONS: Pregnancy did not increase the risk of an ICD-related complication under appropriate management. Additional caution might be required in the postpartum period as well as during pregnancy and labor.


Assuntos
Arritmias Cardíacas/terapia , Desfibriladores Implantáveis , Cardioversão Elétrica/instrumentação , Complicações Cardiovasculares na Gravidez/terapia , Adulto , Antiarrítmicos/uso terapêutico , Arritmias Cardíacas/diagnóstico , Arritmias Cardíacas/fisiopatologia , Cesárea , Cardioversão Elétrica/efeitos adversos , Emergências , Feminino , Idade Gestacional , Humanos , Nascimento Vivo , Período Pós-Parto , Gravidez , Complicações Cardiovasculares na Gravidez/diagnóstico , Complicações Cardiovasculares na Gravidez/fisiopatologia , Desenho de Prótese , Falha de Prótese , Estudos Retrospectivos , Fatores de Risco , Fatores de Tempo , Resultado do Tratamento
17.
Circ J ; 76(9): 2249-54, 2012.
Artigo em Inglês | MEDLINE | ID: mdl-22785004

RESUMO

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.


Assuntos
Pressão Sanguínea , Complexo de Eisenmenger/fisiopatologia , Hipertensão Pulmonar/fisiopatologia , Complicações Cardiovasculares na Gravidez/fisiopatologia , Resultado da Gravidez , Adulto , Complexo de Eisenmenger/mortalidade , Feminino , Humanos , Hipertensão Pulmonar/mortalidade , Valor Preditivo dos Testes , Gravidez , Complicações Cardiovasculares na Gravidez/mortalidade , Estudos Retrospectivos
18.
Masui ; 61(12): 1376-9, 2012 Dec.
Artigo em Japonês | MEDLINE | ID: mdl-23362781

RESUMO

Hereditary angioedema (HAE) is characterized by acute, recurrent attacks of localized edema. Surgical procedures, trauma, and infections have been considered as potential triggers of HAE. Although HAE is a rare genetic disorder, approximately 50-60% of all HAE patients are involved with at least one occurrence of upper airway obstruction. The airway trouble is the most life-threating complication in HAE patients because HAE-related edema does not respond to typical treatment, such as administration of epinephrine, antihistamines, or glucocorticoids. Indeed, mortality rates of laryngeal attack are estimated around 25% to 40%. Here we describe a case of undiagnosed HAE patient undergoing emergency caesarean section under neuraxial blockade. A 31-year-old woman showed multiple regions at her lip margin during surgery and rapidly developed lip swelling after admission to the ward. Neither respiratory nor hemodynamic instability was found during and after surgery. Immediately, in order to assess whether HAE caused these dermatological manifestations, we measured values of both complement component 4 (C4) and functional activity of C1-esterase inhibitor (C1-inh), a protein of the complement system. These laboratory data showed low levels, which were compatible with HAE definition. After commencement of C1-inhibitor replacement therapy, her lip swelling and erythema gradually disappeared without adverse drug reactions. The patient was finally discharged from our institution 10 days after surgery.


Assuntos
Angioedemas Hereditários/complicações , Cesárea , Adulto , Angioedemas Hereditários/diagnóstico , Proteína Inibidora do Complemento C1/uso terapêutico , Emergências , Feminino , Humanos
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