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Zhao Y, Zhao C, Ye Q, Li F, Liu K, Zhao S, Wang J. Childbearing Performances and Outcomes of Female Patients with Rheumatic Mitral Valve Diseases after Different Mitral Interventions. Ann Thorac Cardiovasc Surg 2023; 29:223-232. [PMID: 36878609 PMCID: PMC10587480 DOI: 10.5761/atcs.oa.22-00213] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Accepted: 02/01/2023] [Indexed: 03/06/2023] Open
Abstract
PURPOSE This study aimed to illustrate how percutaneous balloon mitral valvuloplasty (PBMV) and mitral valve (MV) surgeries influence women of childbearing age with rheumatic mitral valve diseases (RMVDs) from two aspects, including clinical outcomes and their postoperative childbearing performances. METHODS Female patients with RMVD who were of childbearing age and underwent MV interventions between 2007 and 2019 at Beijing Anzhen Hospital were identified. Outcomes included all-cause deaths, repeated MV interventions, and atrial fibrillation. A survey about childbearing attempts and complications during pregnancy was also performed during follow-up. RESULTS A total of 379 patients were involved in this study, consisting of 226 cases of mitral valve replacements, 107 cases of mitral valve repairs (MVrs), and 46 cases of PBMVs. PBMV was associated with higher possibilities of repeated MV interventions (P <0.05). Postoperative childbearing attempts were more frequently observed among bioprosthesis, MVr, and PBMV (P <0.05). However, PBMV and MVr showed a higher incidence of cardiac complications during pregnancy as compared to prosthesis replacement (P <0.05). CONCLUSIONS MVr and PBMV are not recommended to young female patients for higher incidences of postoperative complications. Safe pregnancy is more likely to be present among patients with biological prosthesis.
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Affiliation(s)
- 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
| | - Qing Ye
- Department of Cardiac Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Fei Li
- 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
| | - Shihua Zhao
- Department of Magnetic Resonance Imaging, Fuwai Hospital and National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China
| | - Jiangang Wang
- Department of Cardiac Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
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Hussein A, Eid M, Mahmoud SED, Sabry M, Altaher A. The Outcomes of PBMV in Pregnancy, and When is the Best Time? Vasc Health Risk Manag 2023; 19:13-20. [PMID: 36687312 PMCID: PMC9849788 DOI: 10.2147/vhrm.s388754] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2022] [Accepted: 01/05/2023] [Indexed: 01/15/2023] Open
Abstract
Background Percutaneous balloon mitral valvuloplasty (PBMV) is considered the most suitable option for managing symptomatic severe mitral valve stenosis (MS) during pregnancy with favorable anatomy. We do not know the best time to perform PBMV during pregnancy to achieve the best maternal and fetal outcomes. Therefore, we conducted this study to clarify the best procedure timing. Methods This prospective, observational, single-center study involved 44 pregnant patients suffering from symptomatic MS who underwent PBMV from May 2017 to May 2020. A detailed history is taken, full clinical examination, laboratory assessment, 2 D echocardiography, and follow-up during the hospital stay and monthly until labor. Results We found that the mean mitral valve area (MVA) had significantly increased from 1.12 ± 0.24 to 2.09 ± 0.46 cm2 (P < 0.001). The mean pressure gradient across the mitral valve reduced from 17.22 ± 5.55 to 8.94 ± 3.75 mmHg (P < 0.001). The procedures were successful in 91% of the patients. Regarding obstetric outcomes, the incidence of preterm labor, fetal death, and composite adverse outcomes was significantly lower in patients who had the procedure during the second trimester than those who had the procedure during the third trimester. All preterm deliveries and intrauterine fetal deaths occurred at least 21 days after PBMV. The patients showed a statistically significant improvement in NYHA functional classification. Conclusion We can conclude that PBMV performed in pregnant patients is an effective and safe treatment modality, and we observed better obstetric outcomes achieved with early intervention during the second trimester.
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Affiliation(s)
- Ahmed Hussein
- Cardiology Unit, Department of Internal Medicine, Faculty of Medicine, Sohag University Egypt, Sohag, Egypt,Correspondence: Ahmed Hussein, Cardiology Unit, Department of Internal Medicine, Faculty of Medicine, Sohag University, Nasser City, Sohag, 82524, Egypt, Tel +2 01011145537, Fax +2 0934600349, Email
| | - Mohamed Eid
- Cardiology Unit, Department of Internal Medicine, Faculty of Medicine, Sohag University Egypt, Sohag, Egypt
| | - Sharaf E D Mahmoud
- Cardiology Unit, Department of Internal Medicine, Faculty of Medicine, Sohag University Egypt, Sohag, Egypt
| | - Mohamed Sabry
- Department of OB/GYN, Faculty of Medicine, Sohag University Egypt, Sohag, Egypt
| | - Ali Altaher
- Cardiology Unit, Department of Internal Medicine, Faculty of Medicine, Sohag University Egypt, Sohag, Egypt
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Vogel B, Acevedo M, Appelman Y, Bairey Merz CN, Chieffo A, Figtree GA, Guerrero M, Kunadian V, Lam CSP, Maas AHEM, Mihailidou AS, Olszanecka A, Poole JE, Saldarriaga C, Saw J, Zühlke L, Mehran R. The Lancet women and cardiovascular disease Commission: reducing the global burden by 2030. Lancet 2021; 397:2385-2438. [PMID: 34010613 DOI: 10.1016/s0140-6736(21)00684-x] [Citation(s) in RCA: 463] [Impact Index Per Article: 154.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2020] [Revised: 03/08/2021] [Accepted: 03/12/2021] [Indexed: 02/07/2023]
Abstract
Cardiovascular disease is the leading cause of death in women. Decades of grassroots campaigns have helped to raise awareness about the impact of cardiovascular disease in women, and positive changes affecting women and their health have gained momentum. Despite these efforts, there has been stagnation in the overall reduction of cardiovascular disease burden for women in the past decade. Cardiovascular disease in women remains understudied, under-recognised, underdiagnosed, and undertreated. This Commission summarises existing evidence and identifies knowledge gaps in research, prevention, treatment, and access to care for women. Recommendations from an international team of experts and leaders in the field have been generated with a clear focus to reduce the global burden of cardiovascular disease in women by 2030. This Commission represents the first effort of its kind to connect stakeholders, to ignite global awareness of sex-related and gender-related disparities in cardiovascular disease, and to provide a springboard for future research.
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Affiliation(s)
- Birgit Vogel
- Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Monica Acevedo
- Divisón de Enfermedades Cardiovasculares, Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Yolande Appelman
- Amsterdam UMC, VU University Medical Center, Amsterdam, Netherlands
| | - C Noel Bairey Merz
- Barbra Streisand Women's Heart Center, Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Alaide Chieffo
- Interventional Cardiology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Gemma A Figtree
- Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
| | - Mayra Guerrero
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, USA
| | - Vijay Kunadian
- Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Newcastle Upon Tyne, UK; Cardiothoracic Centre, Freeman Hospital, Newcastle upon Tyne Hospitals NHS Foundations Trust, Newcastle Upon Tyne, UK
| | - Carolyn S P Lam
- National Heart Centre Singapore, Singapore; Cardiovascular Sciences Academic Clinical Programme, Duke-National University of Singapore, Singapore
| | - Angela H E M Maas
- Department of Women's Cardiac Health, Radboud University Medical Center, Nijmegen, Netherlands
| | - Anastasia S Mihailidou
- Royal North Shore Hospital, Northern Sydney Local Health District, Sydney, NSW, Australia; Cardiovascular and Hormonal Research Laboratory, Kolling Institute, Sydney, NSW, Australia; Faculty of Medicine and Health Sciences, Macquarie University, Sydney, NSW, Australia
| | - Agnieszka Olszanecka
- 1st Department of Cardiology, Interventional Electrocardiology and Hypertension, Faculty of Medicine, Jagiellonian University Medical College, Krakow, Poland
| | - Jeanne E Poole
- Division of Cardiology, University of Washington Medical Center, Seattle, WA, USA
| | - Clara Saldarriaga
- Department of Cardiology and Heart Failure Clinic, Clinica CardioVID, University of Antioquia, Medellín, Colombia
| | - Jacqueline Saw
- Division of Cardiology, Vancouver General Hospital, Vancouver, BC, Canada
| | - Liesl Zühlke
- Departments of Paediatrics and Medicine, Divisions of Paediatric and Adult Cardiology, Red Cross Children's and Groote Schuur Hospital, University of Cape Town, Cape Town, South Africa
| | - Roxana Mehran
- Icahn School of Medicine at Mount Sinai, New York, NY, USA.
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Tempe DK. Cardiac Anesthesiologist and Global Capacity Building to Tackle Rheumatic Heart Disease. J Cardiothorac Vasc Anesth 2021; 35:1922-1926. [PMID: 33637422 DOI: 10.1053/j.jvca.2021.01.055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Accepted: 01/27/2021] [Indexed: 11/11/2022]
Affiliation(s)
- Deepak K Tempe
- Visiting Professor, Institute of Liver and Biliary Sciences, New Delhi. Professor of Excellence and Former Dean, Maulana Azad Medical College, New Delhi, India.
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Sreerama D, Surana M, Moolchandani K, Chaturvedula L, Keepanasseril A, Keepanasseril A, Pillai AA, Nair NS. Percutaneous balloon mitral valvotomy during pregnancy: A systematic review and meta-analysis. Acta Obstet Gynecol Scand 2020; 100:666-675. [PMID: 33070306 DOI: 10.1111/aogs.14029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Revised: 10/08/2020] [Accepted: 10/13/2020] [Indexed: 11/30/2022]
Abstract
INTRODUCTION The objective of this study was to systematically review the maternal and fetal outcomes in pregnant women who underwent percutaneous balloon mitral valvuloplasty (PBMV) during pregnancy. MATERIAL AND METHODS A search was conducted on MEDLINE and Embase databases to identify studies published between 2000 and 2018 that reported on maternal and fetal outcomes following PBMV performed in pregnancy. Randomized controlled trials, cohort studies, case-control studies, cross-sectional studies and case series with four or more pregnancies in which PBMV was performed during pregnancy were included. Reference lists from relevant articles were also hand-searched for relevant citations. A successful procedure was defined as one where there was a reported improvement in the valve area or reduction in the mitral valve gradient. A random effects model was used to derive pooled estimates of various outcomes and the final estimates were reported as percentages with a 95% confidence interval (95% CI). RESULTS Twenty-one observational studies reporting 745 pregnancies were included in the review, all of them having reported outcomes without a comparison group. Most of the studies fell into the low-risk category as determined using the Joanna Briggs Institute (JBI) critical appraisal checklist for case series. Most of the studies (86%) were reported from low- to middle-income countries and PBMV was mostly performed during the second trimester of pregnancy. Forty-three procedures (5.7%) were unsuccessful, nearly half (n = 19) of them reported among women with the severe subvalve disease (Wilkins subvalve score 3 or more). There were 11 maternal deaths among those with suboptimal valve anatomy (severe subvalve disease or Wilkin score >8). Mitral regurgitation was the most common cardiac complication (12.7%; 95% CI 7.3%-19.1%), followed by restenosis (2.4%; 95% CI 0.02%-7.2%). Pooled incidence of cesarean section was 12.1% (95% CI 3.6%-23.8%), preterm delivery 3.9% (95% CI 0.6%-9.0%), stillbirth 0.9% (95%CI 0.2%-2.2%) and low birthweight 5.4% (95% CI 0.2%-14.7%). CONCLUSIONS PBMV may be an effective and safe procedure for optimizing outcomes in pregnant women with mitral stenosis in the absence of severe subvalve disease.
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Affiliation(s)
- Damini Sreerama
- Department of Obstetrics & Gynaecology, Jawaharlal Institute of Postgraduate Medical Education & Research (JIPMER), Puducherry, India
| | - Mahak Surana
- Department of Obstetrics & Gynaecology, Jawaharlal Institute of Postgraduate Medical Education & Research (JIPMER), Puducherry, India
| | - Kailash Moolchandani
- Department of Obstetrics & Gynaecology, Jawaharlal Institute of Postgraduate Medical Education & Research (JIPMER), Puducherry, India
| | - Latha Chaturvedula
- Department of Obstetrics & Gynaecology, Jawaharlal Institute of Postgraduate Medical Education & Research (JIPMER), Puducherry, India
| | - Arun Keepanasseril
- School of Dentistry, Amrita Institute of Medical Sciences, Kochi, India.,Department of Medicine, McMaster University, Hamilton, Canada
| | - Anish Keepanasseril
- Department of Obstetrics & Gynaecology, Jawaharlal Institute of Postgraduate Medical Education & Research (JIPMER), Puducherry, India
| | - Ajith A Pillai
- Department of Cardiology, Jawaharlal Institute of Postgraduate Medical Education & Research (JIPMER), Puducherry, India
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Lesseps S, Hewett J, Mandal S, Green K. A response to the short communication 'Rheumatic heart disease in pregnancy: Profile of women admitted to a Western Australian tertiary obstetric hospital' by Ongzalima et al. Aust N Z J Obstet Gynaecol 2020; 60:E8. [PMID: 32812232 DOI: 10.1111/ajo.13143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2019] [Accepted: 01/31/2020] [Indexed: 11/29/2022]
Affiliation(s)
- Sophie Lesseps
- Department of Medicine, University College London Medical School, London, UK
| | - Jack Hewett
- Department of Medicine, University College London Medical School, London, UK
| | - Sumona Mandal
- Department of Medicine, University College London Medical School, London, UK
| | - Katie Green
- Department of Medicine, University College London Medical School, London, UK
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Fraccaro C, Tence N, Masiero G, Karam N. Management of Valvular Disease During Pregnancy: Evolving Role of Percutaneous Treatment. ACTA ACUST UNITED AC 2020; 15:e10. [PMID: 32905129 PMCID: PMC7463339 DOI: 10.15420/icr.2020.06] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2020] [Accepted: 05/11/2020] [Indexed: 12/14/2022]
Abstract
Valvular heart disease (VHD) is encountered in approximately 1% of pregnancies, significantly increasing both maternal and foetal risk. Rheumatic VHD remains the most common form in non-Western countries, whereas congenital heart disease dominates in the Western world. The risk of complications varies according to the type and severity of the underlying VHD. Moreover, pregnancy is a hypercoagulable state associated with increased risk of thromboembolism. The authors review the main VHDs encountered during pregnancy, and suggest management strategies based on the 2018 European Society of Cardiology recommendations for the management of pregnant women with VHD, providing an overview of classical and new transcatheter structural therapeutic options with a special focus on radiation exposure and anticoagulation drug management.
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Affiliation(s)
- Chiara Fraccaro
- Interventional Cardiology Unit, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua Padua, Italy
| | - Noemie Tence
- Medico-Surgical Heart Valve Unit, Georges Pompidou European Hospital, University of Paris Paris, France
| | - Giulia Masiero
- Interventional Cardiology Unit, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua Padua, Italy
| | - Nicole Karam
- Medico-Surgical Heart Valve Unit, Georges Pompidou European Hospital, University of Paris Paris, France
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