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1.
Pan Afr Med J ; 35: 6, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32128022

RESUMO

Women with complex functionally univentricular hearts rarely survive into adulthood without corrective or palliative surgery. Reports of pregnancy outcome in this group of patients in resource-poor settings are sparse. We report a case of unrepaired pulmonary atresia ventricular septal defect (VSD) with major aorto-pulmonary collateral arteries (MAPCA) who survived into adulthood and was able to complete a successful pregnancy in a resource-poor country.


Assuntos
Cardiopatias Congênitas/fisiopatologia , Comunicação Interventricular/fisiopatologia , Complicações Cardiovasculares na Gravidez/fisiopatologia , Atresia Pulmonar/fisiopatologia , Adulto , Países em Desenvolvimento , Feminino , Humanos , Gravidez , Resultado da Gravidez
2.
Medicine (Baltimore) ; 99(7): e19156, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-32049843

RESUMO

RATIONALE: Atrial fibrillation (AF) is encountered rarely in pregnancy. Management of maternal AF is challenging as it poses a threat to both maternal and fetal well-being. PATIENT CONCERNS: We report a case of a 35 weeks pregnant woman who presented in emergency with sudden-onset palpitations and mild shortness of breath with no personal/family history of cardiac diseases. DIAGNOSES: Patient's pulse was irregularly irregular with an average rate of 179 beats per minute. The obstetric examination was normal. DIAGNOSIS: High-sensitive cardiac troponin T (hs-cTnT) was elevated. The 12 lead electrocardiogram (ECG) confirmed AF. The obstetric ultrasound, electronic fetal heart rate (EFHR) trace, and maternal echocardiography were normal. INTERVENTIONS: The patient was admitted under joint cardiology and obstetric care and monitored with continuous telemetry. She was commenced on a therapeutic dose of low-molecular weight heparin (LMWH) and intravenous fluid. She received a single 200 Joule synchronized direct current (DC) shock under general anesthesia in operation theater, which reverted the rhythm back to normal. EFHR monitoring was normal pre- and post-DC cardioversion. We acknowledge the unwise use of therapeutic dose of LMWH before DC cardioversion (DCCV) because of a potential need for emergency cesarean delivery for maternal and/or fetal compromise. OUTCOME: The patient remained well and in sinus rhythm after cardioversion. She was discharged home the following day on Flecainide (anti-arrhythmic) and therapeutic dose of low molecular weight heparin (LMWH) and followed up in outpatient clinics frequently. She had a baby at term and received prophylactic LMWH for 10 days post-cesarean. She was discharged from cardiology clinic when she was 10 weeks postnatal, and Flecainide was discontinued. LESSONS: We are reporting this case because of the rarity of the condition and successful use of DCCV for treating maternal AF. High-sensitive cardiac troponin T (hs-cTnT) level is a useful laboratory indicator to gauge the severity of AF in pregnancy. We emphasize to make the arrangements for EFHR monitoring and potential cesarean delivery and advocate cautious use of thromboprophylaxis while planning for electrical cardioversion (ECV) for maternal AF.


Assuntos
Fibrilação Atrial/terapia , Complicações Cardiovasculares na Gravidez/terapia , Adulto , Fibrilação Atrial/diagnóstico , Feminino , Humanos , Gravidez , Complicações Cardiovasculares na Gravidez/diagnóstico
3.
Adv Clin Chem ; 94: 1-30, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-31952570

RESUMO

Hypertensive disorders of pregnancy (HDP) is the most common and widely known as serious complication of pregnancy. As this syndrome is a major leading cause of maternal, fetal, and neonatal morbidity/mortality worldwide, many studies have sought to identify candidate molecules as potential disease biomarkers (DBMs) for use in clinical examinations. Accumulating evidence over the past 2 decades that the many proteolytic peptides appear in human humoral fluids, including peripheral blood, in association with an individual's health condition. This review provides the potential utility of peptidomic analysis for monitoring for pathophysiological status in HDP, and presents an overview of current status of peptide quantification technology. Especially, the technical limitations of the methods used for DBM discovery in the blood are discussed.


Assuntos
Hipertensão/sangue , Peptídeos/sangue , Complicações Cardiovasculares na Gravidez/sangue , Biomarcadores/sangue , Feminino , Humanos , Hipertensão/complicações , Gravidez , Complicações Cardiovasculares na Gravidez/fisiopatologia
4.
Lakartidningen ; 1172020 01 24.
Artigo em Sueco | MEDLINE | ID: mdl-31990362

RESUMO

Peripartum cardiomyopathy is defined as heart failure, with ejection fraction less than 45% that presents late during pregnancy or the first five months postpartum. Despite being described first in 1849 by Ritchie the mechanisms behind the disease are still not fully understood. However, oxidative stress during pregnancy and the cleavage of prolactine into its 16 kDa fragment appears to play a role in the pathophysiology of peripartum cardiomyopathy. In addition to optimal therapy for heart failure bromocriptine, an inhibitor of prolactine release, should be considered. Prevalence and prognosis varies geographically. Most often left ventricular ejection fraction is normalized after six months but sometimes the disease is associated with deteriorating heart failure and death. Therefore it is important for health care professionals caring for women in the peripartum period to be aware of the signs and symptoms of the diagnosis.


Assuntos
Cardiomiopatias , Complicações Cardiovasculares na Gravidez , Transtornos Puerperais , Cardiomiopatias/diagnóstico , Cardiomiopatias/terapia , Diagnóstico Tardio , Feminino , Humanos , Período Periparto , Gravidez , Complicações Cardiovasculares na Gravidez/diagnóstico , Complicações Cardiovasculares na Gravidez/terapia , Transtornos Puerperais/diagnóstico , Transtornos Puerperais/terapia
5.
Medicine (Baltimore) ; 99(4): e18986, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31977915

RESUMO

RATIONALE: Anesthetic management of pregnant women with Fontan circulation remains challenging. There are few reports that describe the anesthetic management of cesarean section after Fontan surgery. Here, we present a case of successful epidural anesthesia in a woman with Fontan circulation who required emergency cesarean section. PATIENT CONCERNS: A 29-year-old woman at gestational week 28 was scheduled for emergency cesarean section because of fetal distress. Her past medical history was significant for congenital transposition of the great arteries that had been treated by Fontan surgery 26 years earlier. Her postoperative course had been uneventful and she had reached a near normal level of activity with no arrhythmias or thrombotic complications. On presentation, her oxygen saturation was approximately 84% and she had digital clubbing. Arterial blood gas analysis showed a PCO2 of 35 mmHg, PO2 of 55.5 mmHg, and hemoglobin of 16.3 g/dL. Her blood coagulation parameters were within normal limits except for a high fibrinogen concentration (4.55 g/L). DIAGNOSIS: The diagnosis was pregnancy requiring emergency cesarean section because of fetal distress. INTERVENTIONS: Before anesthesia, a radial artery line was established for continuous measurement of blood pressure. An air pressure pump was placed on the patient's lower limbs and a low-dose dobutamine infusion was started. Next, epidural anesthesia was successfully performed at L2-3. Five milliliters of 2% lidocaine followed by 10 mL of 0.75% ropivacaine were injected. Dobutamine was infused to maintain a target blood pressure of 100-120/60-70 mmHg. OUTCOMES: The procedure was uneventful with the patient maintaining a stable heart rate of 80 to 90 beats/min and an oxygen saturation of 90% to 94%. A male infant weighing 840 g was delivered. The Apgar score was 9 at 1 and 5 minutes. The patient was transferred to the intensive care unit for 20 hours of monitoring and discharged 9 days later. The neonate was discharged after 2 months of specialist neonatal treatment. LESSONS: Epidural anesthesia may be used in women with Fontan circulation undergoing emergency cesarean section. Knowledge of the physiology of the heart lesion and that of pregnancy are critical to the outcome.


Assuntos
Anestesia Epidural/métodos , Anestesia Obstétrica/métodos , Técnica de Fontan/efeitos adversos , Adulto , Cesárea/métodos , Feminino , Sofrimento Fetal , Humanos , Lactente Extremamente Prematuro , Recém-Nascido , Gravidez , Complicações Cardiovasculares na Gravidez/terapia
7.
BJOG ; 127(1): 47-56, 2020 01.
Artigo em Inglês | MEDLINE | ID: mdl-31512355

RESUMO

OBJECTIVE: To describe the epidemiology of rheumatic heart disease (RHD) in pregnancy in Australia and New Zealand (A&NZ). DESIGN: Prospective population-based study. SETTING: Hospital-based maternity units throughout A&NZ. POPULATION: Pregnant women with RHD with a birth outcome of ≥20 weeks of gestation between January 2013 and December 2014. METHODS: We identified eligible women using the Australasian Maternity Outcomes Surveillance System (AMOSS). De-identified antenatal, perinatal and postnatal data were collected and analysed. MAIN OUTCOME MEASURES: Prevalence of RHD in pregnancy. Perinatal morbidity and mortality. RESULTS: There were 311 pregnancies associated with women with RHD (4.3/10 000 women giving birth, 95% CI 3.9-4.8). In Australia, 78% were Aboriginal or Torres Strait Islander (60.4/10 000, 95% CI 50.7-70.0), while in New Zealand 90% were Maori or Pasifika (27.2/10 000, 95% CI 22.0-32.3). One woman (0.3%) died and one in ten was admitted to coronary or intensive care units postpartum. There were 314 births with seven stillbirths (22.3/1000 births) and two neonatal deaths (6.5/1000 births). Sixty-six (21%) live-born babies were preterm and one in three was admitted to neonatal intensive care or special care units. CONCLUSION: Rheumatic heart disease in pregnancy persists in disadvantaged First Nations populations in A&NZ. It is associated with significant cardiac and perinatal morbidity. Preconception planning and counselling and RHD screening in at-risk pregnant women are essential for good maternal and baby outcomes. TWEETABLE ABSTRACT: Rheumatic heart disease in pregnancy persists in First Nations people in Australia and New Zealand and is associated with major cardiac and perinatal morbidity.


Assuntos
Complicações Cardiovasculares na Gravidez/etnologia , Cardiopatia Reumática/etnologia , Adulto , Índice de Massa Corporal , Feminino , Humanos , Renda , Nova Zelândia/epidemiologia , Nova Zelândia/etnologia , Northern Territory/epidemiologia , Northern Territory/etnologia , Grupo com Ancestrais Oceânicos/etnologia , Paridade , Gravidez , Prevalência , Estudos Prospectivos , Adulto Jovem
8.
Kyobu Geka ; 72(13): 1057-1060, 2019 Dec.
Artigo em Japonês | MEDLINE | ID: mdl-31879379

RESUMO

Pregnant women undergoing mechanical valve replacement are at a considerable risk of thromboembolic events, bleeding, and fetotoxicity associated with the administration of vitamin K antagonists and some other anticoagulants. We present our clinical experience of pregnancy and childbirth in a young woman who underwent aortic valve replacement (AVR) with a mechanical valve. A young woman underwent AVR with a bioprosthetic valve for a diagnosis of aortic regurgitation and bicuspid aortic valve at age 23. Four years later, structural valve deterioration(SVD) of the prosthetic valve necessitated redo AVR with bioprosthesis. Three years after the redo AVR, she developed recurrent SVD of the bioprosthesis, and the 3rd AVR operation was performed using an On-X mechanical valve, which allows reduced anticoagulation. She conceived 5 months after AVR using the On-X valve. Anticoagulation therapy was administered with a low-dose vitamin K antagonist combined with heparin infusion during pregnancy. No anticoagulation-induced maternal and fetal complications occurred throughout the pregnancy. The On-X valve, which allows lower levels of anticoagulation is useful in women wishing to get pregnant.


Assuntos
Bioprótese , Implante de Prótese de Valva Cardíaca , Próteses Valvulares Cardíacas , Complicações Cardiovasculares na Gravidez/cirurgia , Anticoagulantes , Valva Aórtica , Feminino , Humanos , Gravidez , Resultado da Gravidez , Reoperação , Resultado do Tratamento , Adulto Jovem
9.
Zhonghua Fu Chan Ke Za Zhi ; 54(12): 826-832, 2019 Dec 25.
Artigo em Chinês | MEDLINE | ID: mdl-31874472

RESUMO

Objective: To analyze risk factors, cardiovascular complications, time of death, gestational age of delivery and offspring outcomes in the maternal deaths with cardiovascular diseases (CVD). Methods: Totally 4 112 cases of pregnant women with CVD in Shanghai obstetric heart disease intensive care unit within 26 years (from January 1993 to December 2018) were collected, and 20 maternal deaths within these cases were analyzed retrospectively. Results: (1) Among the 20 deaths, structural heart diseases accounted for 90% (18/20), pregnancy induced heart diseases was 10% (2/20) while there was no dysfunctional heart disease. The mortality of pregnant women with CVD was 0.486% (20/4 112). (2) The following risk factors were common in these women, getting pregnant without counselling (95%, 19/20) , New York Heart Association classⅢ or Ⅳcardiac function (70%, 14/20), complicated with pulmonary hypertension (75%, 15/20) and prior heart events (60%, 12/20). And 85% (17/20) deaths occurred in puerperium, 15% (3/20) occurred before labor,while no death occurred during labor. And 65% (13/20) deaths died due to heart failure, 20% (4/20) deaths were due to pulmonary hypertension crisis, 5% (1/20) died on sudden cardiac arrest, rupture of aortic dissection and sudden death, respectively. Conclusions: Women with CVD should get pregnant after strict evaluation. Pulmonary hypertension is one of the most severe contraindications to pregnancy, especially in patients with moderate to severe pulmonary hypertension. The puerperium period is a critical period that threatens the safety of these patients. Since heart failure is the most common cause of death, it is necessary to prevent and treat heart failure and to monitor heart function dynamically, especially in those with structural abnormal heart diseases. Moreover, it is also of importance to standardize antenatal care and to identify the severity of heart diseases in time.


Assuntos
Doenças Cardiovasculares/mortalidade , Unidades de Terapia Intensiva/estatística & dados numéricos , Morte Materna , Mortalidade Materna , Complicações Cardiovasculares na Gravidez/etiologia , Adulto , Causas de Morte , China/epidemiologia , Feminino , Humanos , Serviços de Saúde Materna/organização & administração , Mortalidade Materna/tendências , Gravidez , Complicações Cardiovasculares na Gravidez/diagnóstico , Complicações Cardiovasculares na Gravidez/mortalidade , Resultado da Gravidez , Estudos Retrospectivos , Fatores de Risco
10.
Intern Med ; 58(21): 3099-3102, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31685785

RESUMO

A 30-year-old woman was referred to our hospital to undergo an evaluation for suspected Brugada syndrome. She showed no symptoms, but had a strong family history of sudden cardiac death. During observation, Holter electrocardiography (ECG), which had been performed to investigate her symptoms of occasional dizziness, showed a sinus node dysfunction with an occasional long sinus pause. An implantable cardioverter defibrillator (ICD) was therefore put in place, and bradycardia pacing from the ICD relieved those symptoms during the subsequent 18-month follow-up. The patient completed two pregnancies during the follow-up period. No symptomatic changes occurred during the pregnancies, but ECG indicated that an ST segment elevation in the right precordial leads was attenuated during the second and third trimesters of both pregnancies.


Assuntos
Síndrome de Brugada/terapia , Desfibriladores Implantáveis , Complicações Cardiovasculares na Gravidez/terapia , Adulto , Bradicardia/terapia , Síndrome de Brugada/diagnóstico , Morte Súbita Cardíaca , Eletrocardiografia , Eletrocardiografia Ambulatorial , Feminino , Humanos , Linhagem , Gravidez , Síndrome do Nó Sinusal/diagnóstico , Síndrome do Nó Sinusal/terapia
11.
Pan Afr Med J ; 34: 27, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31762895

RESUMO

The occurrence of myocardial ischemia and myocardial infarction in pregnancy is relatively rare, the occurrence of myocardial infarction in pregnancy is associated with cardiovascular risk factors. The deficiency of coagulation regulatory systems in the occurrence of venous thrombosis is well established; however, their role in arterial thrombosis is controversial. Here, we present an interesting case of a 34-year-old of acute myocardial syndrome without persistent ST segment elevation, which revealed transient protein S deficiency. Management of acute coronary syndrome (ACS) during pregnancy may represent a unique clinical challenge. In this manuscript, we review the clinical presentation, anatomic considerations, and management strategy in our patient presenting with ACS. Objective: this case highlights the importance of multimodality approach to help to obtain a more timely diagnosis of myocardial infarction in pregnancy and the importance collaboration between obstetricians, cardiologists, pediatricians and anesthesiologists to ensure optimal care.


Assuntos
Síndrome Coronariana Aguda/diagnóstico , Infarto do Miocárdio/diagnóstico , Complicações Cardiovasculares na Gravidez/diagnóstico , Deficiência de Proteína S/complicações , Síndrome Coronariana Aguda/etiologia , Adulto , Feminino , Humanos , Infarto do Miocárdio/etiologia , Isquemia Miocárdica/diagnóstico , Isquemia Miocárdica/etiologia , Gravidez
12.
Pan Afr Med J ; 34: 63, 2019.
Artigo em Francês | MEDLINE | ID: mdl-31762927

RESUMO

Bleeding during pregnancy may not be due to obstetric causes. Pregnancy is a predisposing factor for some disorders due to physiological changes. These obstetric bleedings are rare but are responsible for high materno-fetal mortality. Prognosis depends on the speed of diagnosis as well as on multidisciplinary management. Splenic artery aneurysm (SAA) rupture during pregnancy is rare with a dreadful prognosis. Common clinical signs including abdominal pain associated with hypotension and anemia are very misleading for the obstetrician who usually suspects retroplacental hematoma or uterine rupture. We report the case of a pregnant patient requiring emergency laparotomy due to the detection of splenic artery aneurysm rupture on imaging test.


Assuntos
Aneurisma Roto/diagnóstico por imagem , Complicações Cardiovasculares na Gravidez/diagnóstico por imagem , Artéria Esplênica/diagnóstico por imagem , Dor Abdominal/etiologia , Adulto , Aneurisma Roto/cirurgia , Feminino , Humanos , Laparotomia/métodos , Gravidez , Complicações Cardiovasculares na Gravidez/cirurgia , Ruptura Espontânea/diagnóstico por imagem , Ruptura Espontânea/cirurgia
13.
Medicine (Baltimore) ; 98(47): e18109, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31764849

RESUMO

RATIONALE: Pulmonary arterial hypertension (PAH) can lead to an increase in right ventricular load and subsequently heart failure, making severe PAH a contraindication for pregnancy. In addition, PAH may worsen during pregnancy and puerperium, which requires high-quality critical care. This report is the first instance in which a patient with severe PAH, survived a successful atrial septal defect (ASD) repair and bilateral lung transplantation during puerperium. PATIENT CONCERNS: A 42-year-old pregnant woman with congenital heart disease (CHD) and severe PAH was admitted to our hospital for the management of pregnancy and delivery. The patient was diagnosed with severe PAH in 2013, and no significant improvements or deteriorations were found until this pregnancy-related hospital admission. DIAGNOSIS: The patient was diagnosed with CHD and severe PAH in 2013 with color Doppler echocardiography, right cardiac catheterization, and pulmonary perfusion imaging. The patient's mean pulmonary arterial pressure increased to 140 mm Hg during pregnancy, suggesting an exacerbated PAH with high risks to both her and the unborn child. INTERVENTIONS: The patient was treated with PAH-targeting treprostinil injection to reduce pulmonary artery pressure. Caesarean section was performed at 27 weeks and 5 days of gestation. The patient was put under extracorporeal membrane oxygenation (ECMO) with the help of local anesthesia before the operation. The investigators finally conducted a bilateral lung transplantation with a shell incision of the sternum under cardiopulmonary bypass. OUTCOMES: The mother and the neonate survived and recovered well after the operation, and were discharged from the hospital on the fourth month post-hospitalization. LESSONS: Severe PAH is an absolute contraindication for pregnancy. However, for patients who insist on a pregnancy, it could be plausible to proceed with a targeted drug therapy and ECMO after conducting a cesarean section, and finally, a lung transplantation. Multidisciplinary diagnosis and treatment is the key to the successful treatment of a PAH-complicated pregnancy.


Assuntos
Cesárea , Hipertensão Pulmonar/cirurgia , Transplante de Pulmão , Complicações Cardiovasculares na Gravidez , Adulto , Feminino , Cardiopatias Congênitas/complicações , Humanos , Hipertensão Pulmonar/complicações , Hipertensão Pulmonar/terapia , Transplante de Pulmão/métodos , Gravidez , Complicações Cardiovasculares na Gravidez/terapia , Índice de Gravidade de Doença
14.
Medicine (Baltimore) ; 98(48): e18170, 2019 11.
Artigo em Inglês | MEDLINE | ID: mdl-31770267

RESUMO

RATIONALE: The umbilical cord is the way to exchange gas, supply nutrients, excrete metabolized. Thrombosis of the umbilical cord leads to fetal hypoxia, which jeopardizes fetal health and can cause fetal death. Umbilical vessel thrombosis, which is rarely reported, is difficult to detect prenatally. PATIENT CONCERNS: Both pregnant women had an unremarkable pregnancy course until a routine ultrasound scan in the third trimester showed a single umbilical artery. However, one umbilical vein and 2 umbilical arteries were seen during an ultrasound examination at 32 weeks. Case 2 had a better pregnancy outcome because of the timely discovery of this complication. DIAGNOSIS: Both cases were diagnosed as umbilical artery thrombosis. INTERVENTIONS: The first patient received no interventions until they reported decreased fetal movements and gradually disappear. The second patient underwent an emergency cesarean section. OUTCOMES: In Case 1, an emergency ultrasound examination showed intrauterine fetal death, and the patient vaginally delivered a stillborn child weighing 3300 g in a day. In Case 2, a female neonate weighing 2860 g was delivered by cesarean section, and exhibited Apgar scores of 10 and 10 at 1 and 5 minutes. CONCLUSION: In the late-term abortions, obstetricians should be vigilant if ultrasound imaging shows suspected umbilical vascular thrombosis or shows 1 umbilical artery when there had previously been 2. The fetus should be closely monitored and interventions implemented as early as possible to improve the prenatal detection rate of umbilical vessel thrombosis and avoid adverse pregnancy outcomes.


Assuntos
Cesárea/métodos , Intervenção Médica Precoce/métodos , Morte Fetal , Complicações Cardiovasculares na Gravidez , Trombose , Artérias Umbilicais , Adulto , Serviços Médicos de Emergência/métodos , Feminino , Morte Fetal/etiologia , Morte Fetal/prevenção & controle , Monitorização Fetal/métodos , Humanos , Recém-Nascido , Gravidez , Complicações Cardiovasculares na Gravidez/diagnóstico , Complicações Cardiovasculares na Gravidez/fisiopatologia , Resultado da Gravidez , Natimorto , Trombose/complicações , Trombose/diagnóstico , Trombose/fisiopatologia , Ultrassonografia Pré-Natal/métodos , Artérias Umbilicais/diagnóstico por imagem , Artérias Umbilicais/patologia
15.
Presse Med ; 48(12): 1422-1430, 2019 Dec.
Artigo em Francês | MEDLINE | ID: mdl-31679895

RESUMO

Pulmonary hypertension in pregnant women is associated with high mortality and morbidity despite significant improvement in prognosis. Women with pulmonary arterial hypertension (PAH) should be still advised against pregnancy and advised on effective contraceptive methods. Pregnancy may be manageable in women with well controlled PAH or mild pulmonary hypertension (sPAP<50mmHg). When women with PAH choose to continue their pregnancy, they need: management by a multidisciplinary team in an expert centre; continuation or early introduction of targeted PAH therapy; early planned delivery.


Assuntos
Complicações Cardiovasculares na Gravidez , Parto Obstétrico/métodos , Parto Obstétrico/normas , Aconselhamento Diretivo/métodos , Feminino , Humanos , Mortalidade Materna , Cuidado Pré-Concepcional/métodos , Gravidez , Complicações Cardiovasculares na Gravidez/epidemiologia , Complicações Cardiovasculares na Gravidez/terapia , Resultado da Gravidez/epidemiologia , Cuidado Pré-Natal/métodos , Cuidado Pré-Natal/normas , /terapia , Fatores de Risco , Vasodilatadores/uso terapêutico
16.
Braz J Cardiovasc Surg ; 34(5): 627-629, 2019 12 01.
Artigo em Inglês | MEDLINE | ID: mdl-31719015

RESUMO

A 27-year-old woman with sudden back pain was transported to our hospital. Abdominal ultrasonography revealed pregnancy of 28 weeks' gestation. Computed tomography demonstrated a type A aortic dissection. Because of progressive fetal deterioration, an emergency cesarean section was forced to perform. The next day, simple hysterectomy followed by an aortic procedure was completed. Valve-sparing aortic replacement and total arch replacement were employed as central operations. The mother and baby are well 9 months postoperatively. Although the strategy for acute type A aortic dissection during pregnancy is controversial, collaborations among neonatologists, obstetricians, and cardiovascular surgeons can ensure mother and infant survival.


Assuntos
Aneurisma Dissecante/cirurgia , Aneurisma Aórtico/cirurgia , Implante de Prótese de Valva Cardíaca/métodos , Complicações Cardiovasculares na Gravidez/cirurgia , Adulto , Aneurisma Dissecante/diagnóstico por imagem , Aneurisma Aórtico/diagnóstico por imagem , Cesárea , Feminino , Humanos , Gravidez , Complicações Cardiovasculares na Gravidez/diagnóstico por imagem , Resultado da Gravidez , Tomografia Computadorizada por Raios X , Resultado do Tratamento
17.
Clin Ter ; 170(5): e364-e367, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31612194

RESUMO

In the last 40 years, the number of elderly patients that require Assisted Reproductive Technologies (ART) has risen enormously, especially after heterolougus fertilization techniques have become available. In recent years, the incidence of peripartum cardiomyopathy (PPCM) has substantially grown, as a consequence of the combined effect of increased maternal age, consequent high prevalence of hypertension and metabolic syndrome (MS). That cohort of women may be exposed to a greater number of cardiac, obstetric and anesthesio-logical complications, therefore the incidence of medico-legal issues, litigation, liabilities and claims over the past years has significantly risen. Cardiovascular and hormonal changes during pregnancy can challenge even the healthiest of individuals, and in that pregnant population the risk is even greater. These patients should be monitored before the ART, during pregnancy, delivery and puerperium, to avoid heart failure, thrombotic problems, embolic complications, stroke and death. Management issues regarding pregnancy and delivery are elaborate, including anesthesia considerations. This new population of women needs an accurate cardiac risk stratification with a thorough cardiovascular history and examination, 12 lead ECG, and transthoracic echocardiogram. Therefore, a comprehensive multidisciplinary assessment and management can provide the best opportunity to improve maternal and neonatal outcomes.


Assuntos
Síndrome Metabólica/etiologia , Complicações Cardiovasculares na Gravidez/etiologia , Técnicas de Reprodução Assistida/legislação & jurisprudência , Adulto , Fatores Etários , Idoso , Feminino , Humanos , Síndrome Metabólica/prevenção & controle , Gravidez , Complicações Cardiovasculares na Gravidez/prevenção & controle , Gestantes , Técnicas de Reprodução Assistida/efeitos adversos , Fatores de Risco
19.
Heart Surg Forum ; 22(5): E405-E410, 2019 Sep 26.
Artigo em Inglês | MEDLINE | ID: mdl-31596721

RESUMO

BACKGROUND: Rheumatic heart disease (RHD) is the most common cardiac disease in pregnancy in developing countries with the mitral valve being the most affected. In this study, the results of surgical intervention in pregnant women presented with acute malfunctioning mechanical mitral valve were discussed. METHODS: All patients underwent emergency redo mitral valve replacement due to acute malfunctioning mechanical mitral valve during pregnancy in a single center between January 2005 and December 2017. These patients were retrospectively analyzed. Additionally, anticoagulation strategy before the event and outcomes for the mother and the fetus were outlined. RESULTS: Between 2005 and 2017, 16 pregnant women arrived in a single tertiary center with acute malfunctioning mechanical mitral valves. The mean gestational age at the time of presentation was 13.19 ± 2.6 weeks. Fifteen out of the 16 patients changed their anticoagulation regimen either with or without medical advice. After replacing the valve, cardiopulmonary bypass successfully was weaned in 12 patients, who were transferred to the ICU sedated and ventilated with variable doses of chemical Inotropes. The remaining 4 patients died on the table after failure of weaning from bypass. In one case, the patient developed immediate postoperative stroke with the Glasgow Coma Scale (GCS) of 7, CT brain revealed massive infarction, her fetus was not viable, she remained sedated and ventilated, and she passed away on post-operative Day 12, due to pneumonia and sepsis. Another patient, with a viable fetus, passed away on post-operative Day 1, due to low cardiac output. CONCLUSION: Acute malfunctioning MHV during pregnancy represents a real dilemma to patients and caregivers. It carries high fetal and maternal morbidity and mortality, especially in centers with limited resources. We believe that an alternative plane must be formulated for such patients to avoid devastating complications, including maternal and fetal deaths.


Assuntos
Doenças das Valvas Cardíacas/cirurgia , Implante de Prótese de Valva Cardíaca/métodos , Próteses Valvulares Cardíacas/efeitos adversos , Valva Mitral/cirurgia , Complicações Cardiovasculares na Gravidez/cirurgia , Falha de Prótese , Cardiopatia Reumática/cirurgia , Adolescente , Adulto , Anticoagulantes/administração & dosagem , Causas de Morte , Emergências , Feminino , Idade Gestacional , Doenças das Valvas Cardíacas/mortalidade , Implante de Prótese de Valva Cardíaca/mortalidade , Humanos , Período Intraoperatório , Gravidez , Complicações Cardiovasculares na Gravidez/mortalidade , Reoperação , Estudos Retrospectivos , Cardiopatia Reumática/mortalidade , Resultado do Tratamento , Adulto Jovem
20.
Lakartidningen ; 1162019 Sep 13.
Artigo em Sueco | MEDLINE | ID: mdl-31529421

RESUMO

Spontaneous coronary artery dissection can be caused by a tear in the intima or a bleeding in the wall of a coronary artery. It is a possible cause of acute coronary syndrome and should be suspected in patients with few risk factors for coronary artery disease. The condition is overrepresented in women particularly during the peripartum period. We present a case where a 36-year-old woman, three days after delivering her third child, presented with myocardial infarction with nonobstructive coronary arteries. She later presented again with ST-elevation myocardial infarction and coronary angiography with optical coherence tomography revealed coronary dissection that was treated with percutaneous coronary intervention.


Assuntos
Anomalias dos Vasos Coronários , Doenças Vasculares/congênito , Adulto , Angiografia Coronária , Anomalias dos Vasos Coronários/diagnóstico , Anomalias dos Vasos Coronários/diagnóstico por imagem , Anomalias dos Vasos Coronários/cirurgia , Eletrocardiografia , Feminino , Humanos , Equipe de Assistência ao Paciente , Intervenção Coronária Percutânea , Período Periparto , Gravidez , Complicações Cardiovasculares na Gravidez/diagnóstico , Complicações Cardiovasculares na Gravidez/diagnóstico por imagem , Complicações Cardiovasculares na Gravidez/cirurgia , Fatores de Risco , Tomografia de Coerência Óptica , Doenças Vasculares/diagnóstico , Doenças Vasculares/diagnóstico por imagem , Doenças Vasculares/cirurgia
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