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Oben AG, Blanchard CT, Robinson A, Girling I, Joly JM, Cribbs M, Tita A, Casey B, Sinkey R. Racial Disparities in Breastfeeding Rates in Patients with Heart Disease. J Racial Ethn Health Disparities 2025; 12:970-976. [PMID: 38509443 PMCID: PMC11913963 DOI: 10.1007/s40615-024-01933-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2023] [Revised: 01/17/2024] [Accepted: 01/31/2024] [Indexed: 03/22/2024]
Abstract
OBJECTIVE To evaluate racial disparities in breastfeeding rates in patients with heart disease. STUDY DESIGN Retrospective cohort of pregnant patients with maternal cardiac disease managed by a Cardio-Obstetrics program. Patients self-identifying as Non-Hispanic Black (NHB) and Non-Hispanic White (NHW), who attended ≥ 1 prenatal visit at the Cardio-Obstetrics Program and delivered at the same hospital between March 2015 and June 2019 were included. The primary outcome was breastfeeding rate at discharge from the delivery-associated hospitalization. Secondary outcomes included breastfeeding intent on admission and breastfeeding rates at the postpartum visit among patients who initiated breastfeeding. RESULTS 138 pregnant patients with cardiac disease were included: 58 (42%) NHB and 80 (58%) NHW patients. Parity, marital status and insurance were statistically different between groups. NHB patients were more likely to have government insurance compared to NHW patients (77.6% vs. 40%; p < 0.001). There was a significant difference in the intent to breastfeed upon admission for the delivery-associated hospitalization (74.2% NHB vs. NHW 91.3%; p = 0.01), but not at hospital discharge (84.5% NHB vs. 93.8% NHW; p = 0.08). However, breastfeeding rates were significantly lower among NHB patients at the postpartum visit among the entire cohort (38.2% in NHB vs. 61.1% in NHW women; p = 0.036) and among those who initiated breastfeeding (35.3% NHB vs. 61.1% NHW, p = 0.018). CONCLUSIONS Despite similar breastfeeding rates at hospital discharge, NHB patients with maternal cardiac disease were less likely to intend to breastfeed at admission and/or continue breastfeeding by the postpartum visits. Qualitative studies understanding these differences are crucial to improve breastfeeding rates, especially for NHB patients with maternal cardiac disease.
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Affiliation(s)
- Ayamo G Oben
- University of Alabama at Birmingham Marnix E. Heersink School of Medicine, Birmingham, AL, USA.
- Department of Obstetrics & Gynecology, University of Alabama at Birmingham, 1700 6th Ave South, Ste 10270, Birmingham, AL, 35233, USA.
| | - Christina T Blanchard
- University of Alabama at Birmingham Marnix E. Heersink School of Medicine, Birmingham, AL, USA
- Center for Women's Reproductive Health, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Ashton Robinson
- University of Alabama at Birmingham Marnix E. Heersink School of Medicine, Birmingham, AL, USA
| | - Isabel Girling
- University of Alabama at Birmingham Marnix E. Heersink School of Medicine, Birmingham, AL, USA
| | - Joanna M Joly
- University of Alabama at Birmingham Marnix E. Heersink School of Medicine, Birmingham, AL, USA
- Department of Medicine, Division of Cardiovascular Disease, University of Alabama, Birmingham, AL, USA
| | - Marc Cribbs
- University of Alabama at Birmingham Marnix E. Heersink School of Medicine, Birmingham, AL, USA
- Department of Medicine, Division of Cardiovascular Disease, University of Alabama, Birmingham, AL, USA
| | - Alan Tita
- University of Alabama at Birmingham Marnix E. Heersink School of Medicine, Birmingham, AL, USA
- Department of Obstetrics & Gynecology, University of Alabama at Birmingham, 1700 6th Ave South, Ste 10270, Birmingham, AL, 35233, USA
- Center for Women's Reproductive Health, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Brian Casey
- University of Alabama at Birmingham Marnix E. Heersink School of Medicine, Birmingham, AL, USA
- Department of Obstetrics & Gynecology, University of Alabama at Birmingham, 1700 6th Ave South, Ste 10270, Birmingham, AL, 35233, USA
- Center for Women's Reproductive Health, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Rachel Sinkey
- University of Alabama at Birmingham Marnix E. Heersink School of Medicine, Birmingham, AL, USA
- Department of Obstetrics & Gynecology, University of Alabama at Birmingham, 1700 6th Ave South, Ste 10270, Birmingham, AL, 35233, USA
- Center for Women's Reproductive Health, University of Alabama at Birmingham, Birmingham, AL, USA
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Weismann CG, Wedlund F, Ryd TL, von Wowern E, Hlebowicz J. Electrocardiographic proarrhythmic changes in pregnancy of women with CHD. Cardiol Young 2024; 34:1514-1520. [PMID: 38465638 DOI: 10.1017/s1047951124000374] [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] [Indexed: 03/12/2024]
Abstract
OBJECTIVES Pregnancy-related physiological adaptations result in increased heart rate as well as electrocardiographic changes such as a mean QTc prolongation of 27 ms. Pregnant women with CHD are at increased risk for cardiovascular complications. The aim of this study was to identify risk factors for abnormally prolonged QTc interval-a risk factor for ventricular arrhythmias-in pregnant women with CHD. MATERIAL AND METHOD Retrospective longitudinal single-centre study. Pre-pregnancy demographic and electrocardiographic risk factors for abnormal QTc duration during pregnancy of (a) > 460 ms and (b) >27 ms increase were analyzed. RESULTS Eighty-three pregnancies in 63 women were included, of which three had documented arrhythmias. All five Modified World Health Organization Classification of Maternal Cardiovascular Risk (mWHO) classes were represented, with 15 pregnancies (18.1%) in mWHO class I, 26 (31.3%) in mWHO II, 28 (33.7%) in mWHO II-III, 11 (13.3%) in mWHO III, and three pregnancies (3.6%) in mWHO class IV. Heart rate and QTc interval increased, while QRS duration and PR interval shortened during pregnancy. QTc duration of > 460 ms was associated with increased pre-pregnancy QTc interval, QRS duration, and weight, as well as body mass index. QTc increase of > 27 ms was associated with increased heart rate prior to pregnancy. No significant associations of electrocardiographic changes with mWHO class or CHD type were identified. CONCLUSION Increased QTc in pregnant women with CHD was associated with being overweight or having higher heart rate, QRS, or QTc duration prior to pregnancy. These patients should be monitored closely for arrhythmias during pregnancy.
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Affiliation(s)
- Constance G Weismann
- Clinical Sciences Lund, Lund University, Lund, Sweden
- Department of Pediatric Cardiology, Lund University, Skåne University Hospital, Lund, Sweden
- Department of Pediatric Cardiology and Pediatric Intensive Care, Ludwig Maximilium University, Munich, Germany
| | - Frida Wedlund
- Clinical Sciences Lund, Lund University, Lund, Sweden
- Department of Cardiology, Skåne University Hospital, Lund University, Malmö, Sweden
| | | | - Emma von Wowern
- Deptartment of Obstetrics and Gynecology, Skåne University Hospital, Lund, Sweden
- Clinical Sciences Malmö, Lund University, Lund, Sweden
| | - Joanna Hlebowicz
- Clinical Sciences Lund, Lund University, Lund, Sweden
- Department of Cardiology, Skåne University Hospital, Lund University, Lund, Sweden
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Angeli L, Fieni S, Dall'Asta A, Ghi T, De Carolis S, Sorrenti S, Rizzo F, Della Gatta AN, Simonazzi G, Pilu G, Benvenuti M, Luchi C, Simoncini T, Gaibazzi N, Niccoli G, Ardissino D, Frusca T. Mode of delivery and peripartum outcome in women with heart disease according to the ESC guidelines: an Italian multicenter study. J Matern Fetal Neonatal Med 2023; 36:2184221. [PMID: 36935360 DOI: 10.1080/14767058.2023.2184221] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/21/2023]
Abstract
INTRODUCTION The European Society of Cardiology (ESC) guidelines (GL) provide indications on the mode of delivery in women with heart disease. However available data suggests that the rate of Cesarean Delivery (CD) is high and widely variable among such patients. In this study, we aimed to investigate the degree of adherence to the ESC recommendations among women delivering in four tertiary maternity services in Italy and how this affects the maternal and neonatal outcomes. MATERIAL AND METHODS Retrospective multicenter cohort study including pregnant women with heart disease who gave birth between January 2014 and July 2020. Composite adverse maternal outcome (CAM) was defined by the occurrence of one or more of the following: major postpartum hemorrhage, thrombo-embolic or ischemic event, de novo arrhythmia, heart failure, endocarditis, aortic dissection, need for re-surgery, sepsis, maternal death. Composite Adverse Neonatal outcome (CAN) was defined as cord arterial pH <7.00, APGAR <7 at 5 min, admission to the intensive care unit, and neonatal death. We compared the incidence of CAM and CAN between the cases with planned delivery in accordance (group "ESC consistent") or in disagreement (group "ESC not consistent") with the ESC GL. RESULTS Overall, 175 women and 181 liveborn were included. A higher frequency of CAN was found when delivery was not planned accordingly to the ESC guidelines [("ESC consistent" 9/124 (7.2%) vs "ESC not consistent" 13/57 (22.8%) p = 0.002 OR 3.74 (CI 95% 1.49-9.74) , while the occurrence of CAM was comparable between the two groups. At logistic regression analysis, the gestational age at delivery was the only parameter independently associated with the occurrence of CAN (p = 0.006). CONCLUSION Among pregnant women with heart disease, deviating from the ESC guidelines scheduling cesarean delivery does not seem to improve maternal outcomes and it is associated with worse perinatal outcomes, mainly due to lower gestational age at birth.
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Affiliation(s)
- L Angeli
- Department of Maternal Neonatal Medicine, University of Parma, Parma, Italy
| | - S Fieni
- Department of Maternal Neonatal Medicine, University of Parma, Parma, Italy
| | - A Dall'Asta
- Department of Maternal Neonatal Medicine, University of Parma, Parma, Italy
| | - T Ghi
- Department of Maternal Neonatal Medicine, University of Parma, Parma, Italy
| | - S De Carolis
- UOC of Obstetric Pathology, Departement of "Scienze della Salute della Donna, del Bambino e di Sanità Pubblica" Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italy
| | - S Sorrenti
- UOC of Obstetric Pathology, Departement of "Scienze della Salute della Donna, del Bambino e di Sanità Pubblica" Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italy
| | - F Rizzo
- UOC of Obstetric Pathology, Departement of "Scienze della Salute della Donna, del Bambino e di Sanità Pubblica" Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italy
| | - A N Della Gatta
- Obstetric Unit, Department of Medical and Surgical Sciences (DIMEC) IRCSS Sant'Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
| | - G Simonazzi
- Obstetric Unit, Department of Medical and Surgical Sciences (DIMEC) IRCSS Sant'Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
| | - G Pilu
- Obstetric Unit, Department of Medical and Surgical Sciences (DIMEC) IRCSS Sant'Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
| | - M Benvenuti
- Unità di Medicina Materno-Fetale, UOC Ginecologia ed Ostetricia University of Pisa, Pisa, Italy
| | - C Luchi
- Unità di Medicina Materno-Fetale, UOC Ginecologia ed Ostetricia University of Pisa, Pisa, Italy
| | - T Simoncini
- Unità di Medicina Materno-Fetale, UOC Ginecologia ed Ostetricia University of Pisa, Pisa, Italy
| | - N Gaibazzi
- Cardiology Department, University of Parma, Parma, Italy
| | - G Niccoli
- Cardiology Department, University of Parma, Parma, Italy
| | - D Ardissino
- Cardiology Department, University of Parma, Parma, Italy
| | - T Frusca
- Department of Maternal Neonatal Medicine, University of Parma, Parma, Italy
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Piao C, Wang WJ, Deng Y, Wang K. Clinical outcomes of pulmonary hypertension in pregnancy among women with congenital heart disease in China. J Matern Fetal Neonatal Med 2023; 36:2183349. [PMID: 36858404 DOI: 10.1080/14767058.2023.2183349] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/03/2023]
Abstract
OBJECTIVE Pulmonary arterial hypertension (PAH) increases the risk for perinatal women and newborns, especially in women with congenital heart disease (CHD). We explored the maternal, perinatal, and postneonatal outcomes of PAH in pregnant women with CHD in China. METHODS A total of 95 pregnant women with CHD-PAH in Beijing Anzhen Hospital from 2009 to 2013 were included retrospectively. We described their characteristics and examined the associations between the grade of PAH and maternal, perinatal, and postneonatal outcomes. RESULTS The New York Heart Association (NYHA) classification grade, delivery mode, and infant outcomes in CHD-PAH patients were analyzed. Overall 95 patients with CHD-PAH, there were 17 patients in mild group(17.7%), 27 patients in moderate group (28.1%), and 51 patients in severe group (53.1%)。The CHD patients with mild PAH, were mostly NYHA class I-II and CHD patients with severe PAH were NYHA class II-IVs. Cesarean section (67.7%) was the most common method of delivery. The rate of therapeutic abortion in the severe group (76.9%) was obviously higher than that in other groups (11.5% in mild group and moderate group respectively), whereas there was no term delivery in severe group, with 2 cases in mild group and moderated group respectively . The rates of heart failure and therapeutic abortion in pregnant women were positively associated with the severity of PAH. The rate of term delivery was higher in patients whose CHD had been corrected by cardiac surgery (83.3%) before pregnancy. CONCLUSION Patients with severe PAH have poor cardiac adaptability, poor maternal and fetal outcomes, and are contraindicated during pregnancy. Patients with mild PAH are not absolutely contraindicated during pregnancy, but their heart burden increases significantly in the third trimester. Patients in mid-gestation should preferentially be delivered by cesarean section. When pregnant patients prefer to continue pregnancy, their close monitoring is essential. We provide useful data for guiding management of pregnancy and delivery in patients with CHD in China.
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Affiliation(s)
- Chunmei Piao
- Department of Obstetrics and Gynecology, Beijing Anzhen Hospital, Capital Medical University, Beijing, P.R. China.,The Key Laboratory of Remodeling-Related Cardiovascular Diseases, Ministry of Education, Beijing Institute of Heart Lung and Blood Vessel Diseases, Beijing, P.R. China
| | - Wen-Jing Wang
- Department of Obstetrics and Gynecology, Beijing Anzhen Hospital, Capital Medical University, Beijing, P.R. China.,Department of Obstetrics and Gynecology, Beijing Ditan Hospital, Capital Medical University, Beijing, P.R. China
| | - Yue Deng
- Department of Obstetrics and Gynecology, Beijing Anzhen Hospital, Capital Medical University, Beijing, P.R. China
| | - Kefang Wang
- Department of Obstetrics and Gynecology, Beijing Anzhen Hospital, Capital Medical University, Beijing, P.R. China
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Stephens EH, Dearani JA, Overman DM, Deyle DR, Rose CH, Ashikhmina E, Jain CC, Miranda WR, Connolly HM. Pregnancy heart team: A lesion-specific approach. J Thorac Cardiovasc Surg 2022:S0022-5223(22)01356-3. [PMID: 36658028 DOI: 10.1016/j.jtcvs.2022.12.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2022] [Revised: 12/14/2022] [Accepted: 12/15/2022] [Indexed: 12/24/2022]
Affiliation(s)
- Elizabeth H Stephens
- Department of Cardiovascular Surgery, Mayo Clinic-Children's Minnesota Cardiovascular Collaborative, Rochester, Minn.
| | - Joseph A Dearani
- Department of Cardiovascular Surgery, Mayo Clinic-Children's Minnesota Cardiovascular Collaborative, Rochester, Minn
| | - David M Overman
- Children's Heart Clinic, Children's Minnesota, Mayo Clinic-Children's Minnesota Cardiovascular Collaborative, Minneapolis, Minn
| | - David R Deyle
- Department of Clinical Genomics, Mayo Clinic, Rochester, Minn; Department of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, Minn
| | - Carl H Rose
- Obstetrics and Gynecology, Mayo Clinic, Rochester, Minn
| | - Elena Ashikhmina
- Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, Minn
| | - C Charles Jain
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minn
| | | | - Heidi M Connolly
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minn
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Cherpak BV, Davydova YV, Kravchenko VI, Yaschuk NS, Siromakha SO, Lazoryshynets VV. Management of percutaneous treatment of aorta coarctation diagnosed during pregnancy. J Med Life 2022; 15:208-213. [PMID: 35419094 PMCID: PMC8999110 DOI: 10.25122/jml-2021-0363] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2021] [Accepted: 12/15/2021] [Indexed: 11/19/2022] Open
Abstract
Management of coarctation of the aorta (CoA) during pregnancy is complicated by increased procedural risks to the pregnant woman and her fetus. The aim of this research was to analyze 10-years of experience of CoA treatment diagnosed during pregnancy. During 2010–2020 we performed percutaneous stents implantations (SI) in 4 women during 15–23 weeks of pregnancy and in 6 women 48 hours – 5 years after delivery. In all presented cases, successful CoA repair was achieved. There was a significant decrease of peak-to-peak invasive systolic pressure gradient across the CoA (60.0±31.2 and 11.8±7.3 mmHg, p=0.001) and mean noninvasive systolic arterial pressure (163.0±46.2 and 120.5±9.2 mmHg, p=0.01) after SI. All percutaneously treated women during pregnancy (n=4) delivered healthy full-term babies. At follow-up (from 2 months to 10 years), all 10 women are alive without significant Doppler gradient across CoA with no signs of aortic aneurysm formation. To the best of our knowledge, we presented the largest published cohort of CoA percutaneous treatment during pregnancy. We categorized our experience in managing aortic coarctation diagnosed during pregnancy in one algorithm. Our experience demonstrates that excellent maternal and neonatal pregnancy outcomes can be obtained in women after CoA percutaneous repair, diagnosed during pregnancy. An aortic stent implantation is effective and safe for both mother and fetus.
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Affiliation(s)
- Bogdan Volodymyrovych Cherpak
- Pediatric Cardiology and Cardiosurgery Department, National Amosov Institute of Cardiovascular Surgery NAMS, Kyiv, Ukraine,*Corresponding Author: Bogdan Volodymyrovych Cherpak, Pediatric Cardiology and Cardiosurgery Department, National Amosov Institute of Cardiovascular Surgery NAMS, Kyiv, Ukraine. E-mail:
| | - Yulia Volodymyrivna Davydova
- Obstetrics Department for Extragenital Pathology in Pregnant Women, Institute of Pediatrics, Obstetrics and Gynecology NAMS, Kyiv, Ukraine
| | - Vitalii Ivanovich Kravchenko
- Department of Surgical Treatment of Aortic Pathology, National Amosov Institute of Cardiovascular Surgery NAMS, Kyiv, Ukraine
| | - Natalia Sergiivna Yaschuk
- Pediatric Cardiology Intervention Department, National Amosov Institute of Cardiovascular Surgery NAMS, Kyiv, Ukraine
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Liu Y, Li Y, Zhang J, Zhao W, Bao Z, Ma X, Zhao Y, Zhao C, Liu K, Ye Q, Su L, Yang Y, Yang J, Li G, Fan X, Wang J. Pregnancy Complications and Outcomes Among Women With Congenital Heart Disease in Beijing, China. Front Cardiovasc Med 2022; 8:765004. [PMID: 35127849 PMCID: PMC8813973 DOI: 10.3389/fcvm.2021.765004] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2021] [Accepted: 12/24/2021] [Indexed: 11/13/2022] Open
Abstract
Objective To conduct a comparative analysis of the complications and outcomes in pregnant women with and without congenital heart disease (CHD) in Beijing, China. Methods We compared pregnancy-related complications and outcomes experienced by women with and without CHD throughout 19,424 deliveries in Beijing Anzhen Hospital between 2010 and 2019, including cardiovascular and obstetric factors, fetal events, delivery methods, and other complications over a mean 5-years post-delivery follow-up period. Results There were 1,040 women with CHD (5.35% of all deliveries). Compared to women without CHD, these women had longer hospital stays (7.83 ± 4.65 vs. 4.93 ± 3.26 days) and a higher death rate (1.92 vs. 0.02%). They also had a greater risk of comorbidities, including pre-term delivery (odds ratio: 13.65 vs. 6.71), heart failure (odds ratio: 4.90 vs. 0.40), and arrhythmia (odds ratio 12.69 vs. 4.69). Pulmonary hypertension, New York Heart Association functional class III~IV, and no congenital heart disease surgery prior to pregnancy were associated with adverse events such as cesarean section, pre-term delivery, and heart failure. The fetuses of mothers with CHD were more likely to be born pre-term (odds ratio: 13.65 vs. 6.71) and have low birth weight (odds ratio: 8.56 vs. 4.36). Eleven infants (1.82%) born to mothers with CHD and four infants (0.64%) born to mothers without CHD were diagnosed with CHD. Conclusions Women with CHD generally increase maternal and infant risk during pregnancy and the perinatal period. Pulmonary hypertension, decrease in cardiac function, and no previous CHD surgery increase the risk in women with CHD. Greater attention should be paid to pregnant women with CHD and their fetuses, newborns.
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Affiliation(s)
- Yang Liu
- Department of Pediatric Cardiac Center, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Yanna Li
- Department of Obstetrics and Gynecology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Jun Zhang
- Department of Obstetrics and Gynecology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Wenjuan Zhao
- Department of Obstetrics and Gynecology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Zhaoliang Bao
- Department of Obstetrics and Gynecology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Xiaolong Ma
- Department of Cardiac Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Yichen Zhao
- Department of Cardiac Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Cheng Zhao
- Department of Cardiac Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Kemin Liu
- Department of Cardiac Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Qing Ye
- Department of Cardiac Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Lixiao Su
- Department of Biostatistics, NJS Associates Company, Bridgewater, NJ, United States
| | - Yao Yang
- Department of Pediatric Cardiac Center, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Jing Yang
- Department of Pediatric Cardiac Center, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Gang Li
- Department of Pediatric Cardiac Center, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Xiangming Fan
- Department of Pediatric Cardiac Center, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
- Xiangming Fan
| | - Jiangang Wang
- Department of Cardiac Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
- *Correspondence: Jiangang Wang
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Hardee I, Wright L, McCracken C, Lawson E, Oster ME. Maternal and Neonatal Outcomes of Pregnancies in Women With Congenital Heart Disease: A Meta-Analysis. J Am Heart Assoc 2021; 10:e017834. [PMID: 33821681 PMCID: PMC8174159 DOI: 10.1161/jaha.120.017834] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Background With advances in the treatment of congenital heart disease (CHD), more women with CHD survive childhood to reach reproductive age. The objective of this study was to evaluate the maternal and neonatal outcomes of pregnancies among women with CHD in the modern era. Methods and Results We conducted a meta‐analysis of peer‐reviewed literature published January 2007 through June 2019. Studies were included if they reported on maternal or fetal mortality and provided data by CHD lesion. Meta‐analysis was performed using random effect regression modeling using Comprehensive Meta‐Analysis (v3). CHD lesions were categorized as mild, moderate, and severe to allow for pooling of data across studies. Of 2200 articles returned by our search, 32 met inclusion criteria for this study. Overall, the rate of neonatal mortality was 1%, 3.1%, and 3.5% in mild, moderate, and severe lesions, respectively. There were too few maternal deaths in any group to pool data. The rates of maternal and neonatal morbidity among women with CHD increase with severity of lesion. Specifically, rates of maternal arrhythmia and heart failure, cesarean section, preterm birth, and small for gestational age neonate are all markedly increased as severity of maternal CHD increases. Conclusions In the modern era, pregnancy in women with CHD typically has a successful outcome in both mother and child. However, as maternal CHD severity increases, so too does the risk of numerous morbidities and neonatal mortality. These findings may help in counseling women with CHD who plan to become pregnant, especially women with severe lesions.
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Affiliation(s)
- Isabel Hardee
- Department of Pediatrics University of Colorado School of Medicine Denver CO
| | - Lydia Wright
- Department of Pediatrics Emory University School of Medicine, Children's Healthcare of Atlanta Atlanta GA
| | - Courtney McCracken
- Department of Pediatrics Emory University School of Medicine, Children's Healthcare of Atlanta Atlanta GA
| | - Emily Lawson
- Woodruff Health Sciences Center Library Emory University Atlanta GA
| | - Matthew E Oster
- Department of Pediatrics Emory University School of Medicine, Children's Healthcare of Atlanta Atlanta GA
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Fürniss HE, Stiller B. Arrhythmic risk during pregnancy in patients with congenital heart disease. Herzschrittmacherther Elektrophysiol 2021; 32:174-179. [PMID: 33796929 DOI: 10.1007/s00399-021-00754-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2021] [Accepted: 03/16/2021] [Indexed: 11/30/2022]
Abstract
Arrhythmias play a significant role in the morbidity and mortality of patients with adult congenital heart disease (CHD). Pregnancy-associated physiological changes in hormonal status, hemodynamics, and myocardial structure further enhance arrhythmic risk in CHD patients, leading to increased adverse maternal and foetal events and making arrhythmias one of the most common complications during pregnancy. Nearly all CHD patients are affected by asymptomatic rhythm disturbances during the ante-, peri-, or post-partum periods, and almost one tenth of patients develop sustained, symptomatic arrhythmias requiring treatment. The majority of arrhythmias originate from the atrium, mostly in the form of supraventricular tachycardia or atrial fibrillation. Patients with CHD often tolerate these even more poorly during pregnancy than before pregnancy. Sustained ventricular tachycardia or ventricular fibrillation are rare, but potentially life-threatening for mother and foetus. Risk stratification models developed specifically for arrhythmias during pregnancy in CHD patients are lacking, but direct or indirect signs of heart failure, previous history of arrhythmia, and complex CHD may be associated with higher arrhythmic risk in these patients. Rigorous individual assessment before, and careful monitoring during pregnancy in a multidisciplinary team is crucial to ensure the best possible pregnancy outcome for patients with CHD.
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Affiliation(s)
- Hannah E Fürniss
- Department of Congenital Heart Disease and Pediatric Cardiology, University Heart Center Freiburg-Bad Krozingen, Medical Center-University of Freiburg, Faculty of Medicine, Freiburg, Germany.
- Institute for Experimental Cardiovascular Medicine, University Heart Center Freiburg-Bad Krozingen, Medical Center-University of Freiburg, Faculty of Medicine, Freiburg, Germany.
| | - Brigitte Stiller
- Department of Congenital Heart Disease and Pediatric Cardiology, University Heart Center Freiburg-Bad Krozingen, Medical Center-University of Freiburg, Faculty of Medicine, Freiburg, Germany
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Choi EY, Kim ES, Kim JY, Song MK, Kim SH, Noh CI. Pregnancy outcomes in patients with structural heart disease: a single center experience. Cardiovasc Diagn Ther 2021; 11:81-90. [PMID: 33708480 DOI: 10.21037/cdt-20-786] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Background In women, pregnancy is a period of relatively drastic hemodynamic change in a short period of time. Most pregnant women adapt well to these gradual hemodynamic changes. However, in women with congenital heart disease or other structural heart disease, adaptation to theses sudden hemodynamic changes is difficult, and heart failure or arrhythmia can get aggravated. This study shares our experiences on the outcomes of pregnancy in patients with structural heart disease. Methods From January 2007 to December 2016, we reviewed the medical records of all pregnant women with structural heart disease who received obstetric care at the Sejong General Hospital. Results During the study period, 103 pregnancies were observed in 79 women with structural heart disease. Of the 103 pregnancies, 55 were primiparous and 48 were multiparous. Echocardiography performed before pregnancy revealed that 52 patients had moderate to severe valvular regurgitation and 38 patients had moderate to severe valvular stenosis; 22 patients had mechanical valves and 5 patients had pulmonary hypertension. Overall, there were 9 maternal cardiac events, 7 obstetric events and 19 neonatal events. Pulmonary embolic events occurred only in 1 case; 77 deliveries were made, and 26 pregnancies did not last. Among 77 deliveries, 55 patients delivered by cesarean section (C/S) (71.43%). C/S in 16 of 55 patients was performed due to the maternal hemodynamic risk. Conclusions Overall complications associated with pregnancy in women with structural heart disease were very high at 28.16%. However, it is hoped that maternal and neonatal outcomes will be improved through careful observation and preparedness for anticipated complications.
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Affiliation(s)
- Eun-Young Choi
- Department of Pediatrics, College of Medicine, Kangwon National University, Gangwon-do, Korea.,Department of Pediatrics, Sejong General Hospital, Gyeonggi-do, Korea
| | - Eun Sun Kim
- Department of Pediatrics, College of Medicine, Kangwon National University, Gangwon-do, Korea
| | - Jung-Yoon Kim
- Department of Pediatrics, Sejong General Hospital, Gyeonggi-do, Korea
| | - Min-Kyung Song
- Department of Obstetrics and Gynecology, Sejong General Hospital, Gyeonggi-do, Korea
| | - Seong-Ho Kim
- Department of Pediatrics, Sejong General Hospital, Gyeonggi-do, Korea
| | - Chung Il Noh
- Department of Pediatrics, Sejong General Hospital, Gyeonggi-do, Korea
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11
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Tsukinaga A, Yoshitani K, Kubota Y, Kanemaru E, Nishimura K, Ogata S, Nakai M, Tsukinaga R, Kamiya CA, Yoshimatsu J, Ohnishi Y. Anesthesia for Cesarean Section and Postpartum Cardiovascular Events in Congenital Heart Disease: A Retrospective Cohort Study. J Cardiothorac Vasc Anesth 2020; 35:2108-2114. [PMID: 33309496 DOI: 10.1053/j.jvca.2020.11.042] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2020] [Revised: 11/09/2020] [Accepted: 11/18/2020] [Indexed: 11/11/2022]
Abstract
OBJECTIVE To clarify the association between anesthetic technique and maternal and neonatal outcomes in parturients with congenital heart disease (CHD). DESIGN Retrospective, observational cohort study. SETTING An academic hospital. PARTICIPANTS A total of 263 consecutive parturients with CHD who underwent cesarean section from 1994 to 2019. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS The authors compared postpartum cardiovascular events (composite of heart failure, pulmonary hypertension, arrhythmia, and thromboembolic complications) and neonatal outcomes (intubation and Apgar score <7 at one or five minutes) by anesthetic technique. Among 263 cesarean sections, general anesthesia was performed in 47 (17.9%) parturients and neuraxial anesthesia in 214 (81.3%) parturients. Cardiovascular events were more common in the general anesthesia group (n = 7; 14.9%) than in the neuraxial anesthesia group (n = 17; 7.9%). Generalized linear mixed models assuming a binomial distribution (ie, mixed-effects logistic regression), with a random intercept for each modified World Health Organization classification for maternal cardiovascular risk, revealed that general anesthesia was not significantly associated with cardiovascular events (odds ratio [OR], 1.00; 95% confidence interval [CI], 0.30-3.29). In addition, general anesthesia was associated with composite neonatal outcomes (Apgar score <7 at one or five minutes or need for neonatal intubation; OR, 13.3; 95% CI, 5.52-32.0). CONCLUSION Anesthetic technique is not significantly associated with postpartum composite cardiovascular events. General anesthesia is significantly associated with increased need for neonatal intubation and lower Apgar scores.
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Affiliation(s)
- Akito Tsukinaga
- Department of Anesthesiology, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan
| | - Kenji Yoshitani
- Department of Anesthesiology, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan.
| | - Yosuke Kubota
- Department of Anesthesiology, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan
| | - Eiki Kanemaru
- Department of Anesthesiology, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan
| | - Kunihiro Nishimura
- Department of Preventive Medicine and Epidemiology, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan
| | - Soshiro Ogata
- Department of Preventive Medicine and Epidemiology, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan
| | - Michikazu Nakai
- Department of Statistical Analysis, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan
| | - Rie Tsukinaga
- Department of Obstetrics and Gynecology, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan
| | - Chizuko A Kamiya
- Department of Obstetrics and Gynecology, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan
| | - Jun Yoshimatsu
- Department of Obstetrics and Gynecology, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan
| | - Yoshihiko Ohnishi
- Department of Anesthesiology, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan
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12
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Saito K, Toyama H, Okamoto A, Yamauchi M. Management of cesarean section in a patient with Fontan circulation: a case report of dramatic reduction of maternal oxygen consumption after delivery. JA Clin Rep 2020; 6:77. [PMID: 33011935 PMCID: PMC7533274 DOI: 10.1186/s40981-020-00385-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2020] [Revised: 09/15/2020] [Accepted: 09/29/2020] [Indexed: 12/01/2022] Open
Abstract
Background The anesthetic management of cesarean sections in Fontan-palliated parturients requires strict hemodynamic control. However, patient management with central venous oxygen saturation (ScvO2) and oxygen consumption (VO2) has never been reported. Case presentation A 30-year-old woman, who had received a total cavopulmonary connection for tricuspid atresia, was planned to undergo cesarean section at 38 weeks’ gestation. During combined spinal-epidural anesthesia, ScvO2 in addition to arterial pressure-based cardiac output (APCO) and central venous pressure (CVP) was monitored, and the change of VO2 was evaluated. After delivery, her APCO was almost unchanged. However, her ScvO2 increased dramatically from 42.1 to 67.3% and her CVP increased from 9 to 11 mm Hg. The calculated mean maternal VO2 changed from 443 to 295 mL/min. Conclusions In a cesarean section for a Fontan-palliated parturient, ScvO2 dramatically increased and maternal VO2 decreased by more than 25% after delivery.
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Affiliation(s)
- Kazutomo Saito
- Anesthesiology and Perioperative Medicine, Tohoku University Graduate School of Medicine, 2-1 Seiryomachi, Aoba-ku, Sendai, Miyagi, 980-8575, Japan.
| | - Hiroaki Toyama
- Anesthesiology and Perioperative Medicine, Tohoku University Graduate School of Medicine, 2-1 Seiryomachi, Aoba-ku, Sendai, Miyagi, 980-8575, Japan
| | - Atsushi Okamoto
- Department of Anesthesiology, Tohoku University Hospital, 1-1 Seiryomachi, Aoba-ku, Sendai, Miyagi, 980-8575, Japan
| | - Masanori Yamauchi
- Anesthesiology and Perioperative Medicine, Tohoku University Graduate School of Medicine, 2-1 Seiryomachi, Aoba-ku, Sendai, Miyagi, 980-8575, Japan
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13
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Petrus AHJ, Jongert BL, Kiès P, Sueters M, Jongbloed MRM, Vliegen HW, Schalij MJ, van Lith J, van den Akker T. Evaluation of mode of birth in pregnant women with heart disease. Eur J Obstet Gynecol Reprod Biol 2020; 248:150-155. [PMID: 32244032 DOI: 10.1016/j.ejogrb.2020.03.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2019] [Revised: 02/25/2020] [Accepted: 03/05/2020] [Indexed: 12/01/2022]
Abstract
OBJECTIVE Maternal heart disease (HD) complicates 1-4 % of pregnancies and is associated with adverse maternal and fetal outcomes. Although vaginal birth is generally recommended in the guidelines, cesarean section (CS) rates in women with HD are often high. Aim of the present study was to evaluate mode of birth and pregnancy outcomes in women with HD in a tertiary care hospital in the Netherlands. STUDY DESIGN The study population consisted of 128 consecutive pregnancies in 99 women with HD, managed by a pregnancy heart team between 2012-2017 and ending in births after 24 weeks' gestation. Pregnancy risk was assessed per modified World Health Organization class. Mode of birth (planned and performed) and maternal and fetal complications (cardiovascular events, postpartum hemorrhage, prematurity, small for gestational age and death) were assessed for each pregnancy. RESULTS Pregnancy risk was classified as modified World Health Organization class I in 23 %, class II in 50 %, class III in 21 % and class IV in 6% of pregnancies. Planned mode of birth was vaginal in 114 pregnancies (89 %) and CS in 14 (11 %; nine for obstetric and five for cardiac indication). An unplanned CS was performed in 18 pregnancies (16 %; 16 for obstetric and two for cardiac indications). Overall mode of birth was vaginal in 75 % and CS in 25 %. Twelve cardiovascular events occurred in eight pregnancies (6 %), postpartum hemorrhage in nine (7 %) and small for gestational age in 14 (11 %). No maternal or fetal deaths occurred. CONCLUSIONS Findings of this study indicate that - given that pregnancies are managed and mode of birth is meticulously planned by a multidisciplinary pregnancy heart team - vaginal birth is a suitable option for women with HD.
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Affiliation(s)
| | - Britt L Jongert
- Department of Obstetrics, Leiden University Medical Centre, the Netherlands
| | - Philippine Kiès
- Department of Cardiology, Leiden University Medical Centre, the Netherlands
| | - Marieke Sueters
- Department of Obstetrics, Leiden University Medical Centre, the Netherlands
| | | | - Hubert W Vliegen
- Department of Cardiology, Leiden University Medical Centre, the Netherlands
| | - Martin J Schalij
- Department of Cardiology, Leiden University Medical Centre, the Netherlands
| | - Jan van Lith
- Department of Obstetrics, Leiden University Medical Centre, the Netherlands
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14
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Wang K, Xin J, Wang X, Yu H, Liu X. Pregnancy outcomes among 31 patients with tetralogy of Fallot, a retrospective study. BMC Pregnancy Childbirth 2019; 19:486. [PMID: 31823779 PMCID: PMC6902441 DOI: 10.1186/s12884-019-2630-y] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2019] [Accepted: 11/25/2019] [Indexed: 11/29/2022] Open
Abstract
Background Tetralogy of Fallot (TOF) is a severe type of congenital heart disease (CHD) and it confers substantial risk to mother and fetus for pregnant women. However, the outcome of pregnancy in women with TOF has not been well studied. Methods Women with TOF who have been seen and/or delivered at our tertiary-care hospital between April 2008 and January 2018 were retrospective reviewed. Results A total of 31 pregnant women with TOF were identified during ten-year period. Among these patients, cardiac defects remained uncorrected in 12 women and were surgically repaired in 19 women. The frequency of miscarriages, premature birth, and the percentage of neonates of small for gestational age (SGA) were greater in the uncorrected group than the surgically repaired group (16.67% vs 0, 50% vs 5.26, 41.67% vs 10.53% respectively). The neonatal mortality and fetal mortality were not observed in the surgically repaired group, but were observed in the uncorrected group [3.23% (1/31) and 6.45(2/31) respectively]. Furthermore, the obstetric and cardiac complications in the two groups were stratified and analyzed. Conclusions Surgical correction of TOF is associated with improved maternal and perinatal outcome. However, pregnancy in women with uncorrected TOF was still seen and it was observed at a rate of 1.4/10,000 in our medical center during ten year period. The high degree of ventricular dilatation heart, high functional classifications, serious cardiac arrhythmias and pulmonary hypertension appeared to be associated with maternal and neonatal risks.
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Affiliation(s)
- Kana Wang
- Department of Obstetrics and Gynecology, West China Second University Hospital, Sichuan University, No. 20, 3rd section, South Renmin Road, Chengdu, 610041, Sichuan, China.,Key Laboratory of Birth Defects and Related Diseases of Women and Children, Sichuan University, Ministry of Education, No. 20, 3rd section, South Renmin Road, Chengdu, 610041, Sichuan, China
| | - Junguo Xin
- School of Public Heath, Chengdu Medical College, Chengdu, China
| | - Xiaodong Wang
- Department of Obstetrics and Gynecology, West China Second University Hospital, Sichuan University, No. 20, 3rd section, South Renmin Road, Chengdu, 610041, Sichuan, China.,Key Laboratory of Birth Defects and Related Diseases of Women and Children, Sichuan University, Ministry of Education, No. 20, 3rd section, South Renmin Road, Chengdu, 610041, Sichuan, China
| | - Haiyan Yu
- Department of Obstetrics and Gynecology, West China Second University Hospital, Sichuan University, No. 20, 3rd section, South Renmin Road, Chengdu, 610041, Sichuan, China. .,Key Laboratory of Birth Defects and Related Diseases of Women and Children, Sichuan University, Ministry of Education, No. 20, 3rd section, South Renmin Road, Chengdu, 610041, Sichuan, China.
| | - Xinghui Liu
- Department of Obstetrics and Gynecology, West China Second University Hospital, Sichuan University, No. 20, 3rd section, South Renmin Road, Chengdu, 610041, Sichuan, China.,Key Laboratory of Birth Defects and Related Diseases of Women and Children, Sichuan University, Ministry of Education, No. 20, 3rd section, South Renmin Road, Chengdu, 610041, Sichuan, China
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15
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Kloster S, Tolstrup JS, Olsen MS, Johnsen SP, Søndergaard L, Nielsen DG, Ersbøll AK. Neonatal Risk in Children of Women With Congenital Heart Disease: A Cohort Study With Focus on Socioeconomic Status. J Am Heart Assoc 2019; 8:e013491. [PMID: 31656122 PMCID: PMC6898817 DOI: 10.1161/jaha.119.013491] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
Background We hypothesized that women with congenital heart disease (CHD) are at increased risk of giving birth preterm, including very and moderately preterm and giving birth to infants small for gestational age (SGA). We aimed to investigate this in a nation‐wide study with focus on the potential modifying effect of socioeconomic status. Methods and Results We performed a cohort study using Danish nation‐wide registers between 1997 and 2014. The exposure, maternal CHD, was subdivided into simple, moderate and complex based on severity of defects. Outcomes were preterm birth and SGA. Cox regression was used to estimate hazard ratios (HR). A total of 933 149 births including 3745 births among women with CHD were studied. The risk of giving birth preterm and SGA were higher among women with CHD as compared with women without CHD; for example, adjusted hazard ratios of preterm birth according to severity: simple 1.33 (95% CI, 1.11–1.59), moderate 1.45 (95% CI, 1.14–1.83) and complex 3.26 (95% CI, 2.41–4.40). Same pattern was seen for very and moderately preterm births and SGA. Education was a strong predictor of both preterm birth and SGA but did not modify the association between maternal congenital heart disease and preterm birth (P=0.38) or SGA (P=0.99). Conclusions Women with CHD were at increased risk of preterm birth both, moderately and very preterm, as well as giving birth to infants SGA. Education was a strong predictor of both preterm birth and SGA but the association between CHD and risk of preterm birth and SGA was independent of educational level.
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Affiliation(s)
- Stine Kloster
- The National Institute of Public Health University of Southern Denmark Copenhagen Denmark
| | - Janne S Tolstrup
- The National Institute of Public Health University of Southern Denmark Copenhagen Denmark
| | | | | | - Lars Søndergaard
- Department of Cardiology Rigshospitalet Copenhagen Denmark.,University Hospital of Copenhagen Copenhagen Denmark
| | - Dorte Guldbrand Nielsen
- Department of Clinical Medicine Aarhus University Aarhus Denmark.,Department of Cardiology Aarhus University Hospital Aarhus Denmark
| | - Annette Kjær Ersbøll
- The National Institute of Public Health University of Southern Denmark Copenhagen Denmark
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16
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Egbe AC, El-Harasis M, Miranda WR, Ammash NM, Rose CH, Fatola A, Kothapalli S, Abdelsamid MF, Connolly HM. Outcomes of Pregnancy in Patients With Prior Right Ventricular Outflow Interventions. J Am Heart Assoc 2019; 8:e011730. [PMID: 31195875 PMCID: PMC6645649 DOI: 10.1161/jaha.118.011730] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
Background The purpose of this study was to compare the incidence of pregnancy‐related adverse outcomes (PRAO) between patients with versus without hemodynamically significant right ventricle outflow tract (RVOT). Methods and Results This was a retrospective cohort study of all pregnant patients with isolated RVOT lesions undergoing evaluation at the Mayo Clinic, 1990 to 2017. Hemodynamic significance was defined as ≥moderate pulmonary/conduit stenosis (≥3 m/s) and/or ≥moderate regurgitation. Patients with concomitant significant left heart disease were excluded. PRAO was defined as cardiovascular, obstetric, and/or neonatal complications occurring during the pregnancy through 6 weeks postpartum. A total of 224 pregnancies in 114 patients with RVOT lesions were identified; 38 pregnancies occurred in 24 patients with hemodynamically significant RVOT. Forty‐eight (21%) pregnancies ended in spontaneous abortion. Of the 173 completed pregnancies, median gestational age at delivery was 38 (35–40) weeks and median birth weight 2965 (2065–4122) g. Seven pregnancies (4%) were complicated by cardiovascular events, 14 (8%) by obstetric complications, with adverse neonatal outcomes occurring in 38 (22%). There were no maternal deaths. The incidence of spontaneous abortion and PRAO were similar in both the RVOT and hemodynamically significant RVOT groups. As an isolated condition, Tetralogy of Fallot–pulmonary atresia was associated with spontaneous abortion and neonatal complications. Conclusions The risk of cardiovascular complications was low in patients with isolated RVOT lesions, and hemodynamically significant RVOT lesions were not associated with either cardiovascular complications or PRAO. Further studies are required to explore the factors responsible for PRAO in patients with Tetralogy of Fallot–pulmonary atresia.
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Affiliation(s)
- Alexander C Egbe
- 1 Department of Cardiovascular Medicine Mayo Clinic Rochester MN
| | | | | | - Naser M Ammash
- 1 Department of Cardiovascular Medicine Mayo Clinic Rochester MN
| | - Carl H Rose
- 3 Department of Obstetrics and Gynecology Mayo Clinic Rochester MN
| | - Ayotola Fatola
- 1 Department of Cardiovascular Medicine Mayo Clinic Rochester MN
| | | | | | - Heidi M Connolly
- 1 Department of Cardiovascular Medicine Mayo Clinic Rochester MN
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17
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Kinsella CM, Thorne SA, Chong H, Clift PF, Vasallo Peraza R, Perez Torga JE, Roman Rubio PA. Delivery outcomes in women with congenital heart disease: results from the Cuban National Programme for pregnancy and heart disease. JOURNAL OF CONGENITAL CARDIOLOGY 2019. [DOI: 10.1186/s40949-019-0025-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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18
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Massoth C, Zarbock A, Wenk M. [Non-cardiac surgery in adults with congenital heart defects : Most important parameters in anesthesia management]. Anaesthesist 2019; 68:245-258. [PMID: 30911773 DOI: 10.1007/s00101-019-0575-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND Adults with congenital heart disease (CHD) represent an increasing proportion of patients undergoing non-cardiac surgery. OBJECTIVE To identify the most important parameters for management of anesthesia. MATERIAL AND METHODS Evaluation and discussion of the current original research and guideline recommendations. RESULTS There are approximately 300,000 patients with CHD living in Germany. The preoperative evaluation is an important influencing factor affecting perioperative morbidity and mortality. Echocardiography is the key instrument for identifying cardiac conditions predisposing to adverse events. The subdivision of CHD into lesions with left-to-right shunt, obstructive lesions and complex congenital heart diseases facilitates the classification of the pathophysiology. CONCLUSION Decisive for the perioperative outcome of patients with CHD are the identification of high-risk patients, understanding of the individual situation with respect to the underlying pathophysiology and the intraoperative maintenance of cardiac output.
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Affiliation(s)
| | | | - M Wenk
- Klinik für Anästhesiologie, operative Intensivmedizin und Schmerztherapie, Universitätsklinikum Münster, Albert-Schweitzer-Campus 1, A1, 48149, Münster, Deutschland.
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19
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Chen Q, Cao H, Zhang GC, Chen LW, Xu F. Successful totally transthoracic echocardiography guided transcatheter device closure of atrial septal defect in pregnant women. World J Clin Cases 2019; 7:734-741. [PMID: 30968038 PMCID: PMC6448076 DOI: 10.12998/wjcc.v7.i6.734] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2018] [Revised: 02/14/2019] [Accepted: 02/18/2019] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Transcatheter device closure of atrial septal defect (ASD) guided by fluoroscopy and/or transesophageal echocardiography is a mature technology. Little study has focused on whether the technology can be guided totally by transthoracic echocardiography (TTE), even in pregnant women with ASD.
AIM To evaluate the safety and efficacy of totally TTE guided transcatheter device closure of ASD in pregnant women.
METHODS Six pregnant women (gestational age 20-26 wk) with ASD underwent transcatheter device closure totally guided by TTE at our cardiac center from January 2015 to August 2017. A routine transcatheter procedure without fluoroscopy or intubation and a domestic occluder were used in this study.
RESULTS All patients had successful closure with good clinical results, and the overall immediate complete closure rate was 100%. The size of the occluder deployed ranged from 20 to 32 mm (26.7 ± 4.3 mm), the procedure time ranged from 30 to 50 min (41.7 ± 7.5 min), and the length of hospital stay was 2-3 d (mean 2.2 ± 0.4 d). There were no serious cardiovascular related complications, and transient arrhythmias occurred in one patient during the procedure. During the follow-up period (3 mo to 2 years), no occluder dislodgement, residual fistulas, or thromboses occurred. All of the patients underwent vaginal delivery between 36 and 38 wk of gestation.
CONCLUSION Totally TTE guided transcatheter device closure of ASD in pregnant women may be safe and effective.
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Affiliation(s)
- Qiang Chen
- Department of Cardiovascular Surgery, Union Hospital, Fujian Medical University, Fuzhou 350001, Fujian Province, China
| | - Hua Cao
- Department of Cardiovascular Surgery, Union Hospital, Fujian Medical University, Fuzhou 350001, Fujian Province, China
| | - Gui-Can Zhang
- Department of Cardiovascular Surgery, Union Hospital, Fujian Medical University, Fuzhou 350001, Fujian Province, China
| | - Liang-Wan Chen
- Department of Cardiovascular Surgery, Union Hospital, Fujian Medical University, Fuzhou 350001, Fujian Province, China
| | - Fan Xu
- Department of Cardiovascular Surgery, Union Hospital, Fujian Medical University, Fuzhou 350001, Fujian Province, China
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20
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Saito J, Noguchi S, Nakai K, Midorikawa Y, Kimura F, Hirota K. General Anesthetic Management for Emergency Cesarean Section and Postpartum Hemorrhage in a Woman With Fontan Circulation. J Cardiothorac Vasc Anesth 2019; 33:791-795. [DOI: 10.1053/j.jvca.2018.05.012] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2018] [Indexed: 11/11/2022]
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21
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Kronwitter A, Mebus S, Neidenbach R, Tutarel O, Ewert P, Kaemmerer H, Nagdyman N. Psychosocial situation in adults with congenital heart defects today and 20 years ago: Any changes? Int J Cardiol 2019; 275:70-76. [PMID: 30336959 DOI: 10.1016/j.ijcard.2018.10.030] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2018] [Revised: 10/05/2018] [Accepted: 10/08/2018] [Indexed: 10/28/2022]
Abstract
BACKGROUND While diagnosis and treatment of congenital heart diseases have improved over the last two decades, data regarding the course of psychosocial parameters is missing. METHODS In a cross-sectional study, 283 adults with congenital heart disease completed a slightly modified questionnaire that was applied in a comparable study twenty years ago. Significant differences between the two populations as well as possible predictors of psychosocial burden for the recent population were sought. RESULTS Despite the presence of more complex heart defects in the current cohort (p < 0.001), both populations exhibited similar values in the Ability Index. Furthermore, the current cohort reported significantly improved outcomes regarding school performance, employment, and sports. Regarding psychosocial functioning, the current cohort showed better outcomes in the domains of sadness (p < 0.01), independence (p < 0.01), understanding (p < 0.001), and acceptance (p < 0.01) of heart disease. Predictors for a worse psychosocial situation in a multiple regression analysis were anxiety, lack of curiosity, and age over 33. In the current study women, as opposed to men, reported significantly more dissatisfaction with too little information provided about their illness (p < 0.05), higher anxiety levels (p < 0.01), and heightened illness-connected burden (p < 0.05). However, women showed higher levels of independence (p < 0.01) and lower alcohol consumption (p < 0.001). CONCLUSION The psychosocial situation of adults with congenital heart disease has improved over the span of 20 years. However, particular needs and concerns should be addressed individually via doctor-patient communication. The findings here suggest that especially female patients appear to have a higher demand for counselling information, e.g. reproduction issues.
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Affiliation(s)
- Alina Kronwitter
- Department of Pediatric Cardiology and Congenital Heart Disease, German Heart Centre Munich, Technical University of Munich (TUM), Munich, Germany
| | - Siegrun Mebus
- Department of Pediatric Cardiology and Congenital Heart Disease, German Heart Centre Munich, Technical University of Munich (TUM), Munich, Germany
| | - Rhoia Neidenbach
- Department of Pediatric Cardiology and Congenital Heart Disease, German Heart Centre Munich, Technical University of Munich (TUM), Munich, Germany
| | - Oktay Tutarel
- Department of Pediatric Cardiology and Congenital Heart Disease, German Heart Centre Munich, Technical University of Munich (TUM), Munich, Germany
| | - Peter Ewert
- Department of Pediatric Cardiology and Congenital Heart Disease, German Heart Centre Munich, Technical University of Munich (TUM), Munich, Germany
| | - Harald Kaemmerer
- Department of Pediatric Cardiology and Congenital Heart Disease, German Heart Centre Munich, Technical University of Munich (TUM), Munich, Germany
| | - Nicole Nagdyman
- Department of Pediatric Cardiology and Congenital Heart Disease, German Heart Centre Munich, Technical University of Munich (TUM), Munich, Germany.
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22
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Boriani G, Lorenzetti S, Cerbai E, Oreto G, Bronzetti G, Malavasi VL, Biffi A, Padeletti L, Botto G, Diemberger I. The effects of gender on electrical therapies for the heart: physiology, epidemiology, and access to therapies. Europace 2018; 19:1418-1426. [PMID: 28525585 DOI: 10.1093/europace/eux068] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2016] [Accepted: 02/18/2017] [Indexed: 12/19/2022] Open
Abstract
The difference between men and women is clear even just by looking at an electrocardiogram: females present higher resting heart rate, a shorter QRS complex length and greater corrected QT interval. The development of these differences from pubertal age onward suggests that sexual hormones play a key role, although their effect is far from being completely understood. Different incidences between sexes have been reported for many arrhythmias, both ventricular and supraventricular, and also for sudden cardiac death. Moreover, arrhythmias are an important issue during pregnancy, both for diagnosis and treatment. Interestingly, cardiovascular structural and electrophysiological remodelling promoted by exercise training enhances this 'gender effect'. Despite all these relevant issues, we lack gender specific recommendations in the current guidelines for electrical therapies for heart rhythm disorders and heart failure. Even more, we continue to see that fewer women are included in clinical trials and are less referred than men for these treatments.
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Affiliation(s)
- Giuseppe Boriani
- Cardiology Division, Department of Diagnostics, Clinical and Public Health Medicine, University of Modena and Reggio Emilia, Policlinico di Modena, via del Pozzo, 41124 Modena, Italy
| | - Stefano Lorenzetti
- Institute of Cardiology, Department of Experimental, Diagnostic and Specialty Medicine, Institute of Cardiology, University of Bologna, Policlinico S.Orsola-Malpighi, via Massarenti, 40138 Bologna, Italy
| | - Elisabetta Cerbai
- Department of NeuroFarBa, C.I.M.M.B.A., University of Florence, Largo Brambilla, 50134 Florence, Italy
| | - Giuseppe Oreto
- Department of Clinical and Experimental Medicine, University of Messina, via Consolare Valeria, 98125 Messina, Italy
| | - Gabriele Bronzetti
- Pediatric Cardiology, Cardio-Thoracic-Vascular Department, University Hospital Policlinico S.Orsola-Malpighi, via Massarenti, 40138 Bologna, Italy
| | - Vincenzo Livio Malavasi
- Cardiology Division, Department of Diagnostics, Clinical and Public Health Medicine, University of Modena and Reggio Emilia, Policlinico di Modena, via del Pozzo, 41124 Modena, Italy
| | - Alessandro Biffi
- Institute of Sports Medicine and Science, Italian Olympic Committee, Largo Piero Gabrielli, 00197 Rome, Italy
| | - Luigi Padeletti
- University of Florence, Florence, Italy and IRCCS MultiMedica, 20099 Sesto San Giovanni, Italy
| | - Gianluca Botto
- Unit of Electrophysiology, S. Anna Hospital, via Ravona, San Fermo della Battaglia, 22020 Como, Italy
| | - Igor Diemberger
- Institute of Cardiology, Department of Experimental, Diagnostic and Specialty Medicine, Institute of Cardiology, University of Bologna, Policlinico S.Orsola-Malpighi, via Massarenti, 40138 Bologna, Italy
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Warnes CA. Adult congenital heart disease: the challenges of a lifetime. Eur Heart J 2018; 38:2041-2047. [PMID: 28011704 DOI: 10.1093/eurheartj/ehw529] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2016] [Accepted: 10/18/2016] [Indexed: 11/13/2022] Open
Abstract
The growing population of adults with congenital heart disease (CHD) poses challenges for cardiac surgeons, general cardiologists and CHD sub specialists. The patients themselves, often believing themselves to be 'totally corrected' following operative repair, also face challenges with re-operations and lifelong cardiac problems. This review examines the challenges of the past, present and future for both medical providers and patients.
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Affiliation(s)
- Carole A Warnes
- Department of Cardiovascular Diseases, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA
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24
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Non-obstetrical indications for cesarean section: a state-of-the-art review. Arch Gynecol Obstet 2018; 298:9-16. [DOI: 10.1007/s00404-018-4742-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2017] [Accepted: 03/04/2018] [Indexed: 01/31/2023]
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25
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Larson JA, Doyle EA. Transitional Care for Young Adults With Congenital Heart Disease: A Case Study. J Pediatr Health Care 2018; 32:195-200. [PMID: 29290410 DOI: 10.1016/j.pedhc.2017.10.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2017] [Revised: 10/16/2017] [Accepted: 10/26/2017] [Indexed: 11/29/2022]
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Wang K, Wang X, Yu H, Liu X, Xing A, You Y. A single-center experience with 12 consecutive cases of pregnancy among patients with membranous ventricular septal aneurysm. BMC Pregnancy Childbirth 2018; 18:8. [PMID: 29298686 PMCID: PMC5751772 DOI: 10.1186/s12884-017-1646-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2016] [Accepted: 12/21/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Membranous ventricular septal aneurysm (MVSA) is a rare cardiac anomaly that can occur as an isolated entity or being associated with other cardiac malformations. Complications of MVSA include thromboembolism, arrhythmia, rupture, bacterial endocarditis, right ventricular outflow tract obstruction, and atrioventricular valve diseases.The success rate of pregnancy and delivery in patients with MVSA has not been reported in the literature. This study was to assess the clinical implications of this condition from our center's experience. METHODS This was a retrospective study for consecutive 12 pregnancies in women with MVSA, who delivered at a tertiary care center in west China between May 2008 and March 2015. RESULTS All patients with MVSA delivered via caesarian section. One patient with severe pulmonary arterial hypertension expired from pulmonary infection and heart failure after delivery. One patient terminated pregnancy in the second trimester- necessitated by cardiogenic shock. The other mothers had varying degrees of cardiac morbidity, but survived. Ten of thirteen newborns survived. Congenital heart disease and small-for-gestational-age (SGA) of newborn occurred in two cases (one twin and one single gestation). Two of these babies expired. CONCLUSIONS Maternal and neonatal risk appeared associated with heart functional classifications, pulmonary hypertension and histories of cardiac events such as serious cardiac arrhythmia. Accurate diagnosis and care by a multidisciplinary team is recommended for pregnant woman with MVSA.
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Affiliation(s)
- Kana Wang
- Department of Obstetrics and Gynecology, West China Second University Hospital, Sichuan University, Chengdu, China.,Key Laboratory of Birth Defects and Related Diseases of Women and Children, (Sichuan University), Ministry of Education, Chengdu, China
| | - Xiaodong Wang
- Department of Obstetrics and Gynecology, West China Second University Hospital, Sichuan University, Chengdu, China.,Key Laboratory of Birth Defects and Related Diseases of Women and Children, (Sichuan University), Ministry of Education, Chengdu, China
| | - Haiyan Yu
- Department of Obstetrics and Gynecology, West China Second University Hospital, Sichuan University, Chengdu, China. .,Key Laboratory of Birth Defects and Related Diseases of Women and Children, (Sichuan University), Ministry of Education, Chengdu, China.
| | - Xinghui Liu
- Department of Obstetrics and Gynecology, West China Second University Hospital, Sichuan University, Chengdu, China.,Key Laboratory of Birth Defects and Related Diseases of Women and Children, (Sichuan University), Ministry of Education, Chengdu, China
| | - Aiyun Xing
- Department of Obstetrics and Gynecology, West China Second University Hospital, Sichuan University, Chengdu, China.,Key Laboratory of Birth Defects and Related Diseases of Women and Children, (Sichuan University), Ministry of Education, Chengdu, China
| | - Yong You
- Department of Obstetrics and Gynecology, West China Second University Hospital, Sichuan University, Chengdu, China.,Key Laboratory of Birth Defects and Related Diseases of Women and Children, (Sichuan University), Ministry of Education, Chengdu, China
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Abstract
The prevalence of pregnant women with cardiovascular heart disease is increasing. Transthoracic echocardiography is safe during pregnancy, and it is an important diagnostic tool in pregnant women with established heart disease in order to monitor ventricular and valvular anatomy and function. In addition, it can be used to delineate cardiac anatomy in complex congenital heart disease and help stratify maternal risk during pregnancy. This review will focus on the use of echocardiography in the diagnosis and management of pregnant women with common congenital lesions and with prosthetic valves.
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Affiliation(s)
- Meena Narayanan
- Division of Cardiology, Department of Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Uri Elkayam
- Division of Cardiology, Department of Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Tasneem Z Naqvi
- Division of Cardiology, Department of Medicine, College of Medicine, Mayo Clinic, CK27, 13400 E Shea Blvd, Scottsdale, AZ, 85259, USA.
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Abstract
UNLABELLED Introduction CHD occurs in about 1% of the United States population, and is now the most common cardiac condition affecting women during pregnancy. METHODS An anonymous, single-site, cross-sectional, 50-question survey was performed at a national Adult Congenital Heart Disease conference to assess the level of knowledge, attitudes, and perceptions regarding cardiac care during pregnancy in women with CHD. RESULTS A total of 77 women completed the survey. Among them, 50% (n=39) had moderate and 38% (n=29) had severely complex disease; 30% (n=23) of women were told that pregnancy was contraindicated given their underlying cardiac condition. Almost two-thirds (n=50) report being categorised as high risk for adverse cardiovascular events. During pregnancy, 84% (n=65) preferred their cardiologist to have trained in adult CHD, 44% (n=34) were satisfied with adult cardiologists, and 36% (n=28) with paediatric cardiologists. Only 48% (n=37) were aware that a fetal echocardiogram was indicated. Only 35% (n=27) discussed modes of delivery with their providers, and 70% (n=54) preferred their prenatal cardiology visits at an adult hospital. Up to 85% (n=64) of them had discussed contraception with their cardiologists, and 72% (n=56) felt they needed high-risk maternal-fetal medicine to be involved with their care. CONCLUSIONS Despite seeking medical care, these pregnant women did not have a full understanding of their condition and their cardiovascular risk during pregnancy. On the basis of these results, further efforts are needed to improve the knowledge, attitudes, and perceptions of women with CHD in relation to their cardiac and obstetric management during pregnancy.
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Sato H, Kamiya CA, Sawada M, Horiuchi C, Tsuritani M, Iwanaga N, Ohuchi H, Shiraishi I, Ichikawa H, Yoshimatsu J. Changes in echocardiographic parameters and hypertensive disorders in pregnancies of women with aortic coarctation. Pregnancy Hypertens 2017; 10:46-50. [PMID: 29153689 DOI: 10.1016/j.preghy.2017.05.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2016] [Revised: 05/14/2017] [Accepted: 05/27/2017] [Indexed: 12/30/2022]
Abstract
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.
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Affiliation(s)
- Hiroshi Sato
- Department of Perinatology and Gynecology, National Cerebral and Cardiovascular Center, 5-7-1 Fujishirodai, Suita, Osaka 565-8565, Japan.
| | - Chizuko A Kamiya
- Department of Perinatology and Gynecology, National Cerebral and Cardiovascular Center, 5-7-1 Fujishirodai, Suita, Osaka 565-8565, Japan
| | - Masami Sawada
- Department of Perinatology and Gynecology, National Cerebral and Cardiovascular Center, 5-7-1 Fujishirodai, Suita, Osaka 565-8565, Japan
| | - Chinami Horiuchi
- Department of Perinatology and Gynecology, National Cerebral and Cardiovascular Center, 5-7-1 Fujishirodai, Suita, Osaka 565-8565, Japan
| | - Mitsuhiro Tsuritani
- Department of Perinatology and Gynecology, National Cerebral and Cardiovascular Center, 5-7-1 Fujishirodai, Suita, Osaka 565-8565, Japan
| | - Naoko Iwanaga
- Department of Perinatology and Gynecology, National Cerebral and Cardiovascular Center, 5-7-1 Fujishirodai, Suita, Osaka 565-8565, Japan
| | - Hideo Ohuchi
- Department of Pediatric Cardiology, National Cerebral and Cardiovascular Center, 5-7-1 Fujishirodai, Suita, Osaka 565-8565, Japan
| | - Isao Shiraishi
- Department of Pediatric Cardiology, National Cerebral and Cardiovascular Center, 5-7-1 Fujishirodai, Suita, Osaka 565-8565, Japan
| | - Hajime Ichikawa
- Department of Pediatric Cardiovascular Surgery, National Cerebral and Cardiovascular Center, 5-7-1 Fujishirodai, Suita, Osaka 565-8565, Japan
| | - Jun Yoshimatsu
- Department of Perinatology and Gynecology, National Cerebral and Cardiovascular Center, 5-7-1 Fujishirodai, Suita, Osaka 565-8565, Japan
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Ha S, Männistö T, Liu D, Sherman S, Ying Q, Mendola P. Air pollution and cardiovascular events at labor and delivery: a case-crossover analysis. Ann Epidemiol 2017; 27:377-383. [PMID: 28552468 DOI: 10.1016/j.annepidem.2017.05.007] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2016] [Revised: 02/03/2017] [Accepted: 05/07/2017] [Indexed: 10/19/2022]
Abstract
PURPOSE In this case-crossover study, we investigated the odds of having a labor/delivery with cardiovascular event (i.e., ischemic heart disease, stroke, heart failure, cardiac arrest/failure, and other or unspecified cardiovascular events) associated with acute exposure to common air pollutants. METHODS We selected 680 women with singleton pregnancy and cardiovascular events at labor/delivery from 12 U.S. clinical sites (2002-2008). Exposures to six criteria air pollutants, six particulate constituents, and 26 air toxics were obtained using modified Community Multiscale Air Quality models. Conditional logistic regression models calculated the odds ratio (OR) and 95% confidence intervals (CI) comparing exposures during the day of delivery, the week before delivery, and each of the days of the week before delivery to two control periods before and after. RESULTS An interquartile range increase in particulate matter (PM) ≤2.5 microns and nitric oxide exposures during the week before delivery was associated with an 11% (OR 1.11, 95% CI: 1.01-1.23) and 21% (OR 1.21, 95% CI: 1.04-1.42) increased cardiovascular events odds, respectively. These pollutants, sulfur dioxide, carbon monoxide, PM ≤ 10 microns, and some PM constituents showed associations with event odds for days 0, 1, 5, and 6 before delivery. Inverse associations were observed for O3 and some PM constituents as well as air toxics. CONCLUSIONS Cardiovascular events at labor/delivery merit more attention in relation to air pollution.
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Affiliation(s)
- Sandie Ha
- Epidemiology Branch, Division of Intramural Population Health Research, NICHD, Bethesda, MD
| | - Tuija Männistö
- Northern Finland Laboratory Centre NordLab, Oulu, Finland; Department of Clinical Chemistry, University of Oulu, Oulu, Finland; Medical Research Center Oulu, Oulu University Hospital and University of Oulu, Oulu, Finland; National Institute for Health and Welfare, Oulu, Finland
| | - Danping Liu
- Biostatistics and Bioinformatics Branch, Division of Intramural Population Health Research, NICHD, Bethesda, MD
| | | | - Qi Ying
- Texas A&M University, Zachry Department of Civil Engineering, College Station, TX
| | - Pauline Mendola
- Epidemiology Branch, Division of Intramural Population Health Research, NICHD, Bethesda, MD.
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Koerten MA, Niwa K, Szatmári A, Hajnalka B, Ruzsa Z, Nagdyman N, Niggemeyer E, Peters B, Schneider KTM, Kuschel B, Mizuno Y, Berger F, Kaemmerer H, Bauer UMM. Frequency of Miscarriage/Stillbirth and Terminations of Pregnancy Among Women With Congenital Heart Disease in Germany, Hungary and Japan. Circ J 2016; 80:1846-51. [PMID: 27334027 DOI: 10.1253/circj.cj-15-1296] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND The 2011 guidelines of the European Society of Cardiology (ESC) on the management of cardiovascular diseases during pregnancy define the maternal predictors for neonatal complications. The aim of this study was to determine whether these are associated with an increased number of miscarriages/stillbirths and terminations of pregnancy (TOPs) also in patients with congenital heart defects (CHD). METHODS AND RESULTS The 634 women from Germany, Hungary and Japan were surveyed concerning the issues of sexuality and reproductive health, as well as their general life situation and medical care. 25% of the recorded pregnancies in women with CHD resulted in miscarriage, stillbirth or TOP. Affecting 16.8% of all recorded pregnancies, miscarriages or stillbirths occurred more frequently than in the general population and more than previously recorded for patients with CHD. TOP occurred in 8% of the surveyed pregnancies. Underlying maternal predictors for neonatal events had an influence on the number of TOP; among those with underlying predictors, TOP was recorded 3-fold more than in those without such predictors (15.6% vs. 5.5%). Remarkably, a significant deficit regarding the level of information on potential pregnancy-associated risks was observed in all 3 participating countries. CONCLUSIONS Pregnant women with CHD should always be treated and counseled individually by cardiologists, gynecologists, obstetricians and anesthetists with appropriate expert knowledge. (Circ J 2016; 80: 1846-1851).
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Affiliation(s)
- Marc-André Koerten
- German Heart Centre Munich, Department of Paediatric Cardiology and Congenital Heart Defects, Technical University of Munich
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Hebson C, Saraf A, Book WM. Risk Assessment and Management of the Mother with Cardiovascular Disease. Clin Perinatol 2016; 43:1-22. [PMID: 26876118 DOI: 10.1016/j.clp.2015.11.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Chronic medical conditions account for most nonobstetrical pregnancy-related maternal complications. Preconception counseling of women with cardiovascular disease can be aided by an understanding of cardiovascular physiology in pregnancy and risk scores to guide management.
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Affiliation(s)
- Camden Hebson
- Department of Medicine, The Sibley Heart Center, Emory University School of Medicine, 1365 Clifton Road Northeast, Clinic A, 2nd Floor, Cardiology, Atlanta, GA 30322, USA; Department of Pediatrics, The Sibley Heart Center, Emory University School of Medicine, 1365 Clifton Road Northeast, Clinic A, 2nd Floor, Cardiology, Atlanta, GA 30322, USA
| | - Anita Saraf
- Division of Cardiology, Department of Medicine, Emory University School of Medicine, 1365 Clifton Road Northeast, Atlanta, GA 30322, USA
| | - Wendy M Book
- Division of Cardiology, Department of Medicine, Emory Adult Congenital Heart Center, Emory University School of Medicine, 1365 Clifton Road Northeast, Clinic A, 2nd Floor, Cardiology, Atlanta, GA 30322, USA.
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Fallavollita L, Di Gioacchino L, Colaneri M. Pregnancy in woman with anatomically correct malposition of the great arteries. Int J Cardiol 2016; 204:126-7. [PMID: 26657605 DOI: 10.1016/j.ijcard.2015.11.152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2015] [Accepted: 11/22/2015] [Indexed: 11/25/2022]
Affiliation(s)
- Luca Fallavollita
- Unit of Cardiology, Italian National Research Center on Aging, Fermo, 63900, Italy.
| | | | - Massimo Colaneri
- Department of Pediatric and Congenital Cardiac Surgery and Cardiology, Ospedali Riuniti, Ancona, Italy
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Abstract
This article is a review of the literature published during the 12 months of 2015, which is of interest to the congenital cardiac anesthesiologist. While the review is not exhaustive, it identifies 7 themes in the literature for 2015 and cites 78 peer-reviewed publications.
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Affiliation(s)
- Mark Twite
- Children’s Hospital Colorado, Anschutz Medical Campus, Aurora, CO, USA
- University of Colorado School of Medicine, Aurora, CO, USA
| | - Richard J. Ing
- Children’s Hospital Colorado, Anschutz Medical Campus, Aurora, CO, USA
- University of Colorado School of Medicine, Aurora, CO, USA
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