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Bay A, Berghammer M, Burström Å, Holstad Y, Christersson C, Dellborg M, Trzebiatowska-Krzynska A, Sörensson P, Thilén U, Johansson B. Symptoms during pregnancy in primiparous women with congenital heart disease. SCAND CARDIOVASC J 2024; 58:2302135. [PMID: 38192047 DOI: 10.1080/14017431.2024.2302135] [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] [Received: 09/23/2023] [Accepted: 01/01/2024] [Indexed: 01/10/2024]
Abstract
Background: As more women with congenital heart disease (CHD) are reaching childbearing age, it becomes more common for their symptoms to be evaluated during pregnancy. However, pregnancy-related symptoms are similar to those caused by heart disease. This study investigated the prevalence of factors associated with symptoms during pregnancy in women with CHD. Methods: The national birth register was searched for primiparous women with CHD who were registered in the national quality register for patients with CHD. Results: Symptoms during the third trimester were reported in 104 of 465 evaluated women. The most common symptom was palpitations followed by dyspnea. Factors associated with symptoms were tested in a univariable model; higher NYHA classification (>1) (OR 11.3, 95%CI 5.5-23.2), low physical activity (≤3 h/week) (OR 2.1 95%CI 1.3-3.6) and educational level ≤ 12 years (OR 1.9 95%CI 1.2-3.0) were associated with having symptoms. In multivariable analysis, low physical activity level (OR 2.4 95%CI 1.2-5.0) and higher NYHA class (OR 11.3 95%CI 5.0-25.6) remained associated with symptoms during pregnancy. There were no cases with new onset of impaired systemic ventricular function during pregnancy. Conclusion: Symptoms during pregnancy are common in women with CHD but are often already present before pregnancy. Because ordinary symptoms during pregnancy often overlap with symptoms of heart disease, it is important to know if symptoms were present before pregnancy and if they became worse during pregnancy. These results should be included in pre-pregnancy counselling and considered in the monitoring during pregnancy.
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Affiliation(s)
- Annika Bay
- Department of Nursing, Umeå University, Umeå, Sweden
| | - Malin Berghammer
- Institute of Health Sciences, University West and Queen Silvia Children Hospital, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Åsa Burström
- Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden
| | - Ylva Holstad
- Department of Nursing, Umeå University, Umeå, Sweden
| | | | - Mikael Dellborg
- Department of Molecular and Clinical Medicine, Sahlgrenska University Hospital, Gothenburg, Sweden
| | | | - Peder Sörensson
- Department of Medicine, Solna, Karolinska Institutet, Stockholm, Sweden
| | - Ulf Thilén
- Department of Clinical Sciences, Cardiology, Lund University, Lund, Sweden
| | - Bengt Johansson
- Department of Surgical and Perioperative Sciences, Umeå University, Umeå, Sweden
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2
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Ezveci H, Doğru Ş, Akkuş F, Metin ÜS, Gezginc K. Maternal Cardiac Disease and Perinatal Outcomes in a Single Tertiary Care Center. Z Geburtshilfe Neonatol 2024. [PMID: 38830384 DOI: 10.1055/a-2311-4945] [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: 06/05/2024]
Abstract
OBJECTIVE This study aims to compare the perinatal outcomes of pregnant women with heart disease and a healthy pregnant control group, as well as the maternal and newborn outcomes of pregnant women with congenital heart disease and acquired heart disease. MATERIAL METHOD Pregnant women with heart disease and healthy control pregnant women were included in this retrospective study. Sociodemographic data of all patients included in the study were obtained from electronic records. Perinatal outcomes of all patients were compared. RESULTS A total of 258 pregnant women were included in the study. While 129 pregnant women were diagnosed with heart disease, 129 patients were low-risk pregnant women. Preeclampsia (p=0.004) and cesarean section (p=0.01) rates were higher in pregnant women with heart disease compared to healthy pregnant women. Compared with healthy pregnant women, pregnant women with heart disease had a lower birth weight (p=0.003), a higher fetal growth restriction (FGR) rate (p=0.036), lower birth percentiles (p=0.002), a lower 5-minute APGAR (p=0.0001), a higher neonatal intensive care unit (NICU) admission rate (p=0.001), and a longer NICU stay rate (p=0.001). The mean gestational age at birth of pregnant women with congenital heart disease was higher than that of those with acquired heart disease (p=0.017). CONCLUSION It was observed that all maternal heart diseases were associated with adverse perinatal outcomes compared to healthy pregnant women. In this series, perinatal adverse outcomes of pregnant women with congenital and acquired heart disease did not differ.
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Affiliation(s)
- Huriye Ezveci
- Necmettin Erbakan University (NEU) Meram Faculty of Medicine, Clinic of obstetric and gynecology Division of maternal and fetal medicine, Konya, Turkey
| | - Şükran Doğru
- Necmettin Erbakan University (NEU) Meram Faculty of Medicine, Clinic of obstetric and gynecology Division of maternal and fetal medicine, Konya, Turkey
| | - Fatih Akkuş
- Necmettin Erbakan University (NEU) Meram Faculty of Medicine, Clinic of obstetric and gynecology Division of maternal and fetal medicine, Konya, Turkey
| | - Ülfet Sena Metin
- Necmettin Erbakan University (NEU) Meram Faculty of Medicine, Clinic of obstetric and gynecology, Konya, Turkey
| | - Kazim Gezginc
- Necmettin Erbakan University (NEU) Meram Faculty of Medicine, Clinic of obstetric and gynecology Division of maternal and fetal medicine, Konya, Turkey
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3
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Wallet T, Legrand L, Isnard R, Gandjbakhch E, Pousset F, Proukhnitzky J, Dommergues M, Nizard J, Charron P. Pregnancy and cardiac maternal outcomes in women with inherited cardiomyopathy: interest of the CARPREG II risk score. ESC Heart Fail 2024; 11:1506-1514. [PMID: 38361389 PMCID: PMC11098662 DOI: 10.1002/ehf2.14694] [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] [Received: 10/24/2023] [Revised: 12/21/2023] [Accepted: 01/09/2024] [Indexed: 02/17/2024] Open
Abstract
AIMS Inherited cardiomyopathies are relatively rare but carry a high risk of cardiac maternal morbidity and mortality during pregnancy and postpartum. However, data for risk stratification are scarce. The new CARPREG II score improves prediction of prognosis in pregnancies associated with heart disease, though its role in inherited cardiomyopathies is unclear. We aim to describe characteristics and cardiac maternal outcomes in patients with inherited cardiomyopathy during pregnancy, and to evaluate the interest of the CARPREG II risk score in this population. METHODS AND RESULTS In this retrospective single-centre study, 90 consecutive pregnancies in 74 patients were included (mean age 32 ± 5 years), including 28 cases of dilated cardiomyopathy (DCM), 46 of hypertrophic cardiomyopathy, 11 of arrhythmogenic right ventricular cardiomyopathy and 5 of left ventricular noncompaction, excluding peripartum cardiomyopathy. The discriminatory power of several risk scores was assessed by the area under the receiver-operating characteristic curve (AUC). Median CARPREG II score was 2 [0;3] and was higher in the DCM subgroup. A severe cardiac maternal complication was observed in 18 (20%) pregnancies, mainly driven by arrhythmia and heart failure (each event in 10 pregnancies), with 3 cardiovascular deaths. Forty-three pregnancies (48%) presented foetal/neonatal complications (18 premature delivery, 3 foetal/neonatal death). CARPREG II was significantly associated with cardiac maternal complications (P < 0.05 for all) and showed a higher AUC (0.782) than CARPREG (0.755), mWHO (0.697) and ZAHARA (0.604). CONCLUSIONS Pregnancy in women with inherited cardiomyopathy carries a high risk of maternal cardiovascular complications. CARPREG II is the most efficient predictor of cardiovascular complications in this population.
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Affiliation(s)
- Thomas Wallet
- Department of Cardiology, APHP, ICAN (Institute of CardioMetabolism and Nutrition), Pitié‐Salpêtrière HospitalACTION Study groupParisFrance
- Sorbonne UniversityParisFrance
| | - Lise Legrand
- Department of Cardiology, APHP, ICAN (Institute of CardioMetabolism and Nutrition), Pitié‐Salpêtrière HospitalACTION Study groupParisFrance
| | - Richard Isnard
- Department of Cardiology, APHP, ICAN (Institute of CardioMetabolism and Nutrition), Pitié‐Salpêtrière HospitalACTION Study groupParisFrance
- Sorbonne UniversityParisFrance
| | - Estelle Gandjbakhch
- Department of Cardiology, APHP, ICAN (Institute of CardioMetabolism and Nutrition), Pitié‐Salpêtrière HospitalACTION Study groupParisFrance
- Sorbonne UniversityParisFrance
| | - Françoise Pousset
- Department of Cardiology, APHP, ICAN (Institute of CardioMetabolism and Nutrition), Pitié‐Salpêtrière HospitalACTION Study groupParisFrance
| | - Julie Proukhnitzky
- Department of Cardiology, APHP, ICAN (Institute of CardioMetabolism and Nutrition), Pitié‐Salpêtrière HospitalACTION Study groupParisFrance
- Sorbonne UniversityParisFrance
- Department of GeneticsAPHP, National Referral Center for Inherited Cardiac Diseases, Inserm UMR_1166ParisFrance
| | - Marc Dommergues
- Sorbonne UniversityParisFrance
- Department of Gynecology and ObstetricsAPHP, Pitié‐Salpêtrière HospitalParisFrance
| | - Jacky Nizard
- Sorbonne UniversityParisFrance
- Department of Gynecology and ObstetricsAPHP, Pitié‐Salpêtrière HospitalParisFrance
| | - Philippe Charron
- Department of Cardiology, APHP, ICAN (Institute of CardioMetabolism and Nutrition), Pitié‐Salpêtrière HospitalACTION Study groupParisFrance
- Sorbonne UniversityParisFrance
- Department of GeneticsAPHP, National Referral Center for Inherited Cardiac Diseases, Inserm UMR_1166ParisFrance
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4
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Richardson M, Bonnet JP, Coulon C, Domanski O, Constans B, Estevez MG, Gautier S, Marsili L, Hamoud YO, Coisne A, Ridon H, Polge AS, Mouton S, Haddad Y, Juthier F, Moussa M, Vehier CM, Lemesle G, Schurtz G, Garabedian C, Jourdain M, Ninni S, Brigadeau F, Montaigne D, Lamblin N, Ghesquiere L. Management and outcomes of pregnant women with cardiovascular diseases in a cardio-obstetric team. Arch Cardiovasc Dis 2024; 117:343-350. [PMID: 38644069 DOI: 10.1016/j.acvd.2024.02.009] [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] [Received: 12/12/2023] [Revised: 02/24/2024] [Accepted: 02/26/2024] [Indexed: 04/23/2024]
Abstract
BACKGROUND Cardiovascular diseases (CVDs) are currently the leading cause of maternal death in Western countries. Although multidisciplinary cardio-obstetric teams are recommended to improve the management of pregnant women with CVD, data supporting this approach are scarce. AIMS To describe the characteristics and outcomes of pregnant patients with CVD managed within the cardio-obstetric programme of a tertiary centre. METHODS We included every pregnant patient with history of CVD managed by our cardio-obstetric team between June 2017 and December 2019, and collected all major cardiovascular events (death, heart failure, acute coronary syndromes, stroke, endocarditis and aortic dissection) that occurred during pregnancy, peripartum and the following year. RESULTS We included 209 consecutive pregnancies in 202 patients. CVDs were predominantly valvular heart diseases (37.8%), rhythm disorders (26.8%), and adult congenital heart diseases (22.5%). Altogether, 47.4% were classified modified World Health Organization (mWHO)>II, 66.5% had CARdiac disease in PREGnancy score (CARPREG II)≥2 and 80 pregnancies (38.3%) were delivered by caesarean section. Major cardiovascular events occurred in 16 pregnancies (7.7%, 95% confidence interval [CI] 4.5-12.2) during pregnancy and in three others (1.5%, 95% CI 0.3-4.1) during 1-year follow-up. Most events (63.1%) occurred in the 16.3% of patients with unknown CVD before pregnancy. CONCLUSIONS The management of pregnant patients with CVD within a cardio-obstetric team seems encouraging as we found a relatively low rate of cardiovascular events compared to the high-risk profile of our population. However, most of the remaining events occurred in patients without cardiac monitoring before pregnancy.
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Affiliation(s)
- Marjorie Richardson
- Department of Clinical Physiology and Echocardiography, Heart Valve Clinic, Heart and Lung Institute, Lille University Hospital, Lille, France.
| | - Jean Philippe Bonnet
- Department of Clinical Physiology and Echocardiography, Heart Valve Clinic, Heart and Lung Institute, Lille University Hospital, Lille, France
| | - Capucine Coulon
- Department of Obstetrics, Jeanne-de-Flandre Maternity, Lille University Hospital, Lille, France
| | - Olivia Domanski
- Department of Paediatrics and Congenital Heart Diseases, Heart and Lung Institute, Lille University Hospital, Lille, France
| | - Benjamin Constans
- Department of Anaesthesia, Jeanne-de-Flandre Maternity, Lille University Hospital, Lille, France
| | - Max Gonzalez Estevez
- Department of Anaesthesia, Jeanne-de-Flandre Maternity, Lille University Hospital, Lille, France
| | - Sophie Gautier
- Department of Pharmacology, Lille University Hospital, Lille, France
| | - Luisa Marsili
- Department of Clinical Genetic, Lille University Hospital, Lille, France
| | - Yasmine Ould Hamoud
- Department of Obstetrics, Jeanne-de-Flandre Maternity, Lille University Hospital, Lille, France
| | - Augustin Coisne
- Department of Clinical Physiology and Echocardiography, Heart Valve Clinic, Heart and Lung Institute, Lille University Hospital, Lille, France; Cardiovascular Research Foundation, New York, NY, USA; Inserm, U1011-EGID, Institut Pasteur de Lille, University of Lille, CHU de Lille, 59000 Lille, France; Faculté de médecine de Lille, université de Lille, Lille, France; European Genomic Institute for Diabetes (E.G.I.D.), FR 3508, Lille, France
| | - Hélène Ridon
- Department of Clinical Physiology and Echocardiography, Heart Valve Clinic, Heart and Lung Institute, Lille University Hospital, Lille, France
| | - Anne-Sophie Polge
- Department of Clinical Physiology and Echocardiography, Heart Valve Clinic, Heart and Lung Institute, Lille University Hospital, Lille, France
| | - Stéphanie Mouton
- Department of Clinical Physiology and Echocardiography, Heart Valve Clinic, Heart and Lung Institute, Lille University Hospital, Lille, France
| | - Yasmine Haddad
- Department of Clinical Physiology and Echocardiography, Heart Valve Clinic, Heart and Lung Institute, Lille University Hospital, Lille, France
| | - Francis Juthier
- Faculté de médecine de Lille, université de Lille, Lille, France; Department of Surgery, Heart Valve Clinic, Heart and Lung Institute, Lille University Hospital, Lille, France; Inserm U1011, Institut Pasteur de Lille, Lille, France
| | - Mouhamed Moussa
- Department of Anaesthesia, Heart Valve Clinic, Heart and Lung Institute, Lille University Hospital, Lille, France
| | - Claire Mounier Vehier
- Department of Vascular Medicine and Hypertension, Heart and Lung Institute, Lille University Hospital, Lille, France
| | - Gilles Lemesle
- Faculté de médecine de Lille, université de Lille, Lille, France; Cardiac Intensive Care Unit, Heart and Lung Institute, CHU de Lille, Lille, France; FACT (French Alliance for Cardiovascular Trial), Paris, France
| | - Guillaume Schurtz
- Cardiac Intensive Care Unit, Heart and Lung Institute, CHU de Lille, Lille, France
| | - Charles Garabedian
- Department of Obstetrics, Jeanne-de-Flandre Maternity, Lille University Hospital, Lille, France; Faculté de médecine de Lille, université de Lille, Lille, France; METRICS, ULR 2694, Assessment of Health Technologies and Medical Practices, Lille, France
| | - Mercedes Jourdain
- Faculté de médecine de Lille, université de Lille, Lille, France; Intensive Care Unit, CHU de Lille, Lille, France; Inserm U1190, Lille, France
| | - Sandro Ninni
- Faculté de médecine de Lille, université de Lille, Lille, France; European Genomic Institute for Diabetes (E.G.I.D.), FR 3508, Lille, France; Department of Cardiology, Heart and Lung Institute, Lille University Hospital, Lille, France
| | - François Brigadeau
- Department of Cardiology, Heart and Lung Institute, Lille University Hospital, Lille, France
| | - David Montaigne
- Department of Clinical Physiology and Echocardiography, Heart Valve Clinic, Heart and Lung Institute, Lille University Hospital, Lille, France; Inserm, U1011-EGID, Institut Pasteur de Lille, University of Lille, CHU de Lille, 59000 Lille, France; Faculté de médecine de Lille, université de Lille, Lille, France; European Genomic Institute for Diabetes (E.G.I.D.), FR 3508, Lille, France
| | - Nicolas Lamblin
- Faculté de médecine de Lille, université de Lille, Lille, France; Cardiac Intensive Care Unit, Heart and Lung Institute, CHU de Lille, Lille, France; Inserm U1167, Institut Pasteur de Lille, Lille, France
| | - Louise Ghesquiere
- Department of Obstetrics, Jeanne-de-Flandre Maternity, Lille University Hospital, Lille, France; Faculté de médecine de Lille, université de Lille, Lille, France; METRICS, ULR 2694, Assessment of Health Technologies and Medical Practices, Lille, France
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5
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Rahnama N, Jemâa NB, Colson A, Pasquet A, de Castro LH, Debiève F, Pierard S. Pregnancy in women with congenital heart disease: New insights into neonatal risk prediction. Am Heart J 2024:S0002-8703(24)00095-4. [PMID: 38679190 DOI: 10.1016/j.ahj.2024.04.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2023] [Revised: 04/16/2024] [Accepted: 04/16/2024] [Indexed: 05/01/2024]
Abstract
BACKGROUND Advances in managing adult congenital heart disease (ACHD) have led to an increased number of women with CHD reaching childbearing age. This demographic shift underscores the need for improved understanding and prediction of complications during pregnancy in this specific ACHD population. Despite progress in maternal cardiac risk assessment, the prediction of neonatal outcomes for ACHD pregnancies remains underdeveloped. Therefore, the aims of this study are to assess neonatal outcomes in a CHD women population, to identify their predictive factors and to propose a new risk score for predicting neonatal complications. METHODS This registry study included all women born between 1975 and 1996 diagnosed with ACHD who underwent at least one cardiology consultation for ACHD in Cliniques Universitaires Saint-Luc. A multivariate analysis was performed to identify predictors of neonatal complications and these were incorporated into a new risk index. Its validity was assessed using bootstrap method. This score was then compared with scores adapted from the ZAHARA and CARPREG studies for offspring events prediction. RESULTS Analysis of 491 pregnancies revealed 31.4% of neonatal complications. Four significant predictors of adverse neonatal outcomes were identified: cardiac treatment during pregnancy (OR 14.8, 95%CI [3.4-66]), hypertensive disorders of pregnancy (OR 11.4, 95%CI [3.4-39.0]), smoking during pregnancy (OR 10.6, 95%CI [2.8-40.6]), and pre-pregnancy BMI <18.5 kg/m² (OR 6.5, 95%CI [2.5-16.5]). The risk model demonstrated an AUC of 0.70 (95%CI [0.65-0.75]), which remained stable after bootstrap validation. This model significantly outperformed the scores adapted from ZAHARA and CARPREG data. Based on the regression coefficients, a risk score was subsequently developed comprising five risk categories. CONCLUSIONS One third of ACHD pregnancies are complicated by poor neonatal outcome. These complications are determined by four independent factors relating to the cardiac and non-cardiac status of the patients, which have been incorporated into a risk score. Our study is one of the first to propose a predictive risk score of neonatal outcomes in ACHD pregancies, and paves the way for other validation and confirmation studies.
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Affiliation(s)
- Nour Rahnama
- Cardiovascular Department, Cliniques Universitaires Saint-Luc, Brussels, Belgium; Pôle de Recherche Cardiovasculaire (CARD), Institut de Recherche Expérimentale et Clinique (IREC), Université Catholique de Louvain (UCLouvain), Brussels, Belgium
| | - Nour Ben Jemâa
- Université Catholique de Louvain (UCLouvain), Brussels, Belgium
| | - Arthur Colson
- Obstetrics Department, Cliniques Universitaires Saint-Luc, Brussels, Belgium; Physiopathologie de la Reproduction (REPR), Institut de Recherche Expérimentale et Clinique (IREC), Université Catholique de Louvain (UCLouvain), Brussels, Belgium
| | - Agnès Pasquet
- Cardiovascular Department, Cliniques Universitaires Saint-Luc, Brussels, Belgium; Pôle de Recherche Cardiovasculaire (CARD), Institut de Recherche Expérimentale et Clinique (IREC), Université Catholique de Louvain (UCLouvain), Brussels, Belgium
| | | | - Frédéric Debiève
- Obstetrics Department, Cliniques Universitaires Saint-Luc, Brussels, Belgium; Physiopathologie de la Reproduction (REPR), Institut de Recherche Expérimentale et Clinique (IREC), Université Catholique de Louvain (UCLouvain), Brussels, Belgium
| | - Sophie Pierard
- Cardiovascular Department, Cliniques Universitaires Saint-Luc, Brussels, Belgium; Pôle de Recherche Cardiovasculaire (CARD), Institut de Recherche Expérimentale et Clinique (IREC), Université Catholique de Louvain (UCLouvain), Brussels, Belgium.
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6
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Montanaro C, Boyle S, Wander G, Johnson MR, Roos-Hesselink JW, Patel R, Rafiq I, Silversides CK, Gatzoulis MA. Pregnancy in Patients with the Fontan Operation. Eur J Prev Cardiol 2024:zwae157. [PMID: 38669446 DOI: 10.1093/eurjpc/zwae157] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2024] [Revised: 04/03/2024] [Accepted: 04/23/2024] [Indexed: 04/28/2024]
Abstract
Improved survival rates for patients with a Fontan circulation has allowed more women with this complex cardiac physiology to contemplate pregnancy. However, pregnancy in women with a Fontan circulation is associated with a high risk of adverse maternal and fetal outcomes, high rates of miscarriage and preterm delivery. Factors associated with a successful pregnancy outcome are: younger age, normal body weight, absence of significant functional limitation, no Fontan-related complications, and well-functioning single ventricle physiology. Appropriate care with timely preconception counselling and regular, frequent clinical reviews by a multidisciplinary team based at a tertiary centre, improves the chance of a successful pregnancy. Empowerment of patients with education on their specific congenital cardiac condition and its projected trajectory, helps them make informed choices regarding their health, reproductive choices and assists them to achieve their life goals.
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Affiliation(s)
- C Montanaro
- Adult Congenital Heart Centre and National Centre for Pulmonary Hypertension, Royal Brompton Hospital, Guy's and St Thomas's NHS Foundation Trust, London, United Kingdom
- National Heart and Lung Institute, Imperial College, London, United Kingdom
| | - S Boyle
- Adult Congenital Heart Centre and National Centre for Pulmonary Hypertension, Royal Brompton Hospital, Guy's and St Thomas's NHS Foundation Trust, London, United Kingdom
- Department of Cardiology, Logan Hospital, Queensland, Australia
| | - G Wander
- Imperial College London, , Chelsea and Westminster Hospital, 369 Fulham Road, London, United Kingdom
| | - M R Johnson
- National Heart and Lung Institute, Imperial College, London, United Kingdom
- Imperial College London, , Chelsea and Westminster Hospital, 369 Fulham Road, London, United Kingdom
| | | | - R Patel
- National Heart and Lung Institute, Imperial College, London, United Kingdom
- Imperial College London, , Chelsea and Westminster Hospital, 369 Fulham Road, London, United Kingdom
| | - I Rafiq
- Adult Congenital Heart Centre and National Centre for Pulmonary Hypertension, Royal Brompton Hospital, Guy's and St Thomas's NHS Foundation Trust, London, United Kingdom
| | - C K Silversides
- Congenital Cardiac Centre for Adults, Peter Munk Cardiac Centre, University Health Network, Toronto, Ontario, Canada
| | - M A Gatzoulis
- Adult Congenital Heart Centre and National Centre for Pulmonary Hypertension, Royal Brompton Hospital, Guy's and St Thomas's NHS Foundation Trust, London, United Kingdom
- National Heart and Lung Institute, Imperial College, London, United Kingdom
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7
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Ceasovschih A, Șorodoc V, Covantsev S, Balta A, Uzokov J, Kaiser SE, Almaghraby A, Lionte C, Stătescu C, Sascău RA, Onofrei V, Haliga RE, Stoica A, Bologa C, Ailoaei Ș, Şener YZ, Kounis NG, Șorodoc L. Electrocardiogram Features in Non-Cardiac Diseases: From Mechanisms to Practical Aspects. J Multidiscip Healthc 2024; 17:1695-1719. [PMID: 38659633 PMCID: PMC11041971 DOI: 10.2147/jmdh.s445549] [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: 12/18/2023] [Accepted: 04/10/2024] [Indexed: 04/26/2024] Open
Abstract
Despite the noteworthy advancements and the introduction of new technologies in diagnostic tools for cardiovascular disorders, the electrocardiogram (ECG) remains a reliable, easily accessible, and affordable tool to use. In addition to its crucial role in cardiac emergencies, ECG can be considered a very useful ancillary tool for the diagnosis of many non-cardiac diseases as well. In this narrative review, we aimed to explore the potential contributions of ECG for the diagnosis of non-cardiac diseases such as stroke, migraine, pancreatitis, Kounis syndrome, hypothermia, esophageal disorders, pulmonary embolism, pulmonary diseases, electrolyte disturbances, anemia, coronavirus disease 2019, different intoxications and pregnancy.
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Affiliation(s)
- Alexandr Ceasovschih
- Faculty of Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, Iasi, Romania
- 2nd Internal Medicine Department, “Sf. Spiridon” Clinical Emergency Hospital, Iasi, Romania
| | - Victorița Șorodoc
- Faculty of Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, Iasi, Romania
- 2nd Internal Medicine Department, “Sf. Spiridon” Clinical Emergency Hospital, Iasi, Romania
| | - Serghei Covantsev
- Department of Research and Clinical Development, Botkin Hospital, Moscow, Russia
| | - Anastasia Balta
- Faculty of Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, Iasi, Romania
- 2nd Internal Medicine Department, “Sf. Spiridon” Clinical Emergency Hospital, Iasi, Romania
| | - Jamol Uzokov
- Department of Cardiology, Republican Specialized Scientific Practical Medical Center of Therapy and Medical Rehabilitation, Tashkent, Uzbekistan
| | - Sergio E Kaiser
- Discipline of Clinical and Experimental Pathophysiology, Rio de Janeiro State University, Rio de Janeiro, Brazil
| | - Abdallah Almaghraby
- Department of Cardiology, Ibrahim Bin Hamad Obaidallah Hospital, Ras Al Khaimah, United Arab Emirates
| | - Cătălina Lionte
- Faculty of Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, Iasi, Romania
- 2nd Internal Medicine Department, “Sf. Spiridon” Clinical Emergency Hospital, Iasi, Romania
| | - Cristian Stătescu
- Faculty of Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, Iasi, Romania
- Department of Cardiology, “Prof. Dr. George I.M. Georgescu” Cardiovascular Diseases Institute, Iasi, Romania
| | - Radu A Sascău
- Faculty of Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, Iasi, Romania
- Department of Cardiology, “Prof. Dr. George I.M. Georgescu” Cardiovascular Diseases Institute, Iasi, Romania
| | - Viviana Onofrei
- Faculty of Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, Iasi, Romania
- Department of Cardiology, “Sf. Spiridon” Clinical Emergency Hospital, Iasi, Romania
| | - Raluca Ecaterina Haliga
- Faculty of Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, Iasi, Romania
- 2nd Internal Medicine Department, “Sf. Spiridon” Clinical Emergency Hospital, Iasi, Romania
| | - Alexandra Stoica
- Faculty of Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, Iasi, Romania
- 2nd Internal Medicine Department, “Sf. Spiridon” Clinical Emergency Hospital, Iasi, Romania
| | - Cristina Bologa
- Faculty of Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, Iasi, Romania
- 2nd Internal Medicine Department, “Sf. Spiridon” Clinical Emergency Hospital, Iasi, Romania
| | - Ștefan Ailoaei
- Department of Cardiology, “Prof. Dr. George I.M. Georgescu” Cardiovascular Diseases Institute, Iasi, Romania
| | - Yusuf Ziya Şener
- Department of Internal Medicine, Hacettepe University Faculty of Medicine, Ankara, Turkiye
| | - Nicholas G Kounis
- Department of Internal Medicine, Division of Cardiology, University of Patras Medical School, Patras, Greece
| | - Laurențiu Șorodoc
- Faculty of Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, Iasi, Romania
- 2nd Internal Medicine Department, “Sf. Spiridon” Clinical Emergency Hospital, Iasi, Romania
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8
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McCoy JA, Kim YY, Nyman A, Levine LD. Pregnancy-related cardiac outcomes among patients with congenital heart disease after formalization of a cardio-obstetrics program. Am J Obstet Gynecol MFM 2024; 6:101335. [PMID: 38460824 PMCID: PMC11081825 DOI: 10.1016/j.ajogmf.2024.101335] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2023] [Revised: 02/22/2024] [Accepted: 02/27/2024] [Indexed: 03/11/2024]
Abstract
BACKGROUND The prevalence of pregnant patients with congenital heart disease (CHD) is increasing, and these patients are at high risk for cardiac morbidity. OBJECTIVE This study aimed to examine the pregnancy outcomes in patients with congenital heart disease before and after the establishment of formal cardio-obstetrics collaboration between adult congenital heart disease and maternal-fetal medicine programs. STUDY DESIGN This was a retrospective cohort study of pregnant patients with congenital heart disease from 2002 to 2020 at a single urban academic institution in the United States. This study included patients with a singleton pregnancy who continued a pregnancy beyond 20 weeks of gestation. The primary outcome was a composite adverse maternal cardiac outcome, compared before (2002-2010) and after (2011-2020) the program. The secondary outcomes included gestational age at delivery, mode of delivery, rate of labor induction, use of diuresis after delivery, and a composite maternal morbidity outcome. RESULTS The number of pregnant patients with congenital heart disease increased after formalization of the cardio-obstetrics program (200 [postprogram group] vs 84 [preprogram group]; 0.48% of all deliveries in the postprogram group vs 0.25% of all deliveries in the preprogram group; P<.001). The postprogram group was more likely to undergo labor induction than the preprogram group (126 [63%] vs 34 [41%], respectively; P<.001). There were fewer patients in the postprogram group than in the preprogram group who were New York Heart Association class II to IV (23 [12%] vs 17 [22%], respectively; P=.04) or with systemic ventricular dysfunction (8 [4%] vs 12 [16%], respectively; P=.001). There was no difference in the primary outcome (38 [19%] in the postprogram group vs 14 [17%] in the preprogram group; P=.64), even after adjusting for confounders, including New York Heart Association class >I and systemic ventricular dysfunction (adjusted odds ratio, 2.3; 95% confidence interval, 0.96-5.4). Patients in the postprogram group were more likely to receive diuresis after delivery than patients in the preprogram group, even in the absence of heart failure or pulmonary edema (9 [4.5%] vs 0 [0.0%], respectively; P=.04). CONCLUSION In the period after the establishment of a formal cardio-obstetrics program between adult congenital heart disease and maternal-fetal medicine, the number of patients with congenital heart disease delivering at our institution increased significantly. Overall, fewer patients entered pregnancy with advanced-stage heart failure or systemic ventricular dysfunction, possibly suggesting improved prepregnancy cardiac care or improved preconception counseling. Composite maternal cardiac outcomes were similar, but the rates of postpartum diuresis increased significantly, suggesting increased attention to volume status in the postpartum period. Formalized collaboration between congenital heart disease and maternal-fetal medicine may help better optimize patients' care before conception, during pregnancy, and after delivery.
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MESH Headings
- Humans
- Female
- Pregnancy
- Heart Defects, Congenital/epidemiology
- Heart Defects, Congenital/physiopathology
- Heart Defects, Congenital/complications
- Retrospective Studies
- Adult
- Pregnancy Outcome/epidemiology
- Pregnancy Complications, Cardiovascular/epidemiology
- Pregnancy Complications, Cardiovascular/physiopathology
- Pregnancy Complications, Cardiovascular/therapy
- Gestational Age
- Labor, Induced/statistics & numerical data
- Labor, Induced/methods
- United States/epidemiology
- Delivery, Obstetric/methods
- Delivery, Obstetric/statistics & numerical data
- Cohort Studies
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Affiliation(s)
- Jennifer A McCoy
- Maternal-Fetal Medicine Research Program, Department of Obstetrics and Gynecology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA (Drs McCoy and Levine).
| | - Yuli Y Kim
- Division of Cardiology, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA (Dr Kim); Division of Cardiology, Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, PA (Dr Kim and Ms Nyman)
| | - Annique Nyman
- Division of Cardiology, Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, PA (Dr Kim and Ms Nyman)
| | - Lisa D Levine
- Maternal-Fetal Medicine Research Program, Department of Obstetrics and Gynecology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA (Drs McCoy and Levine)
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9
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Shapiro H, Alshawabkeh L. Valvular Heart Disease in Pregnancy. Methodist Debakey Cardiovasc J 2024; 20:13-23. [PMID: 38495658 PMCID: PMC10941694 DOI: 10.14797/mdcvj.1323] [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] [Received: 11/29/2023] [Accepted: 01/20/2024] [Indexed: 03/19/2024] Open
Abstract
Valvular heart disease is a common cause of peripartum cardiovascular morbidity and mortality. The hemodynamic changes of pregnancy and their impact on preexisting valvular lesions are described in this paper. Tools for calculation of maternal and fetal risk during pregnancy are also discussed. The pathophysiology and management of valvular lesions, both obstructive and regurgitant, are then described, followed by discussion of mechanical and bioprosthetic valve complications during pregnancy.
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Affiliation(s)
- Hilary Shapiro
- University of California, San Diego, San Diego, California, US
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10
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Tamirisa KP, Oliveros E, Paulraj S, Mares AC, Volgman AS. An Overview of Arrhythmias in Pregnancy. Methodist Debakey Cardiovasc J 2024; 20:36-50. [PMID: 38495654 PMCID: PMC10941715 DOI: 10.14797/mdcvj.1325] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2023] [Accepted: 12/27/2023] [Indexed: 03/19/2024] Open
Abstract
Cardiovascular disease significantly jeopardizes pregnancies in the United States, impacting 1% to 4% of pregnancies annually. Among complications, cardiac arrhythmias are prevalent, posing concerns for maternal and fetal health. The incidence of arrhythmias during pregnancy is rising, partly due to advances in congenital heart surgery and a growing population of women with structural heart disease. While most arrhythmias are benign, the increasing prevalence of more serious arrhythmias warrants a proactive approach. Guidance and reassurance suffice in many cases, but persistent symptoms require cautious use of antiarrhythmic drugs or other therapies for a safe outcome. Managing more serious arrhythmias requires a comprehensive, multidisciplinary approach involving specialists, including maternal-fetal medicine physicians, cardiologists, electrophysiologists, and anesthesiologists.
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11
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Rajpal S, Rodriguez CP. High-Risk Congenital Heart Disease in Pregnancy. Methodist Debakey Cardiovasc J 2024; 20:24-35. [PMID: 38495662 PMCID: PMC10941697 DOI: 10.14797/mdcvj.1306] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2023] [Accepted: 01/03/2024] [Indexed: 03/19/2024] Open
Abstract
High-risk congenital heart disease (CHD) in pregnancy presents a complex clinical challenge. With improved medical care and increased survival rates, a growing population of adults with complex CHD are surviving to adulthood, including women of reproductive age. This chapter focuses on risk stratification and management of pregnant women with high-risk CHD, emphasizing the importance of considering both anatomical and physiological complexity. Maternal physiological changes, such as blood volume increase, cardiac output changes, and alterations in vascular resistance, can significantly impact high-risk CHD patients. Management of high-risk CHD in pregnancy necessitates a multidisciplinary approach and individualized care.
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Affiliation(s)
- Saurabh Rajpal
- The Ohio State University Wexner Medical Center, Columbus, Ohio, US
- Nationwide Children’s Hospital, Columbus, Ohio, US
| | - Carla P. Rodriguez
- Nationwide Children’s Hospital, Columbus, Ohio, US
- Boston Children’s Hospital and Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts, US
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12
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Jonsson S, Sundström-Poromaa I, Johansson B, Alenius Dahlqvist J, Christersson C, Dellborg M, Trzebiatowska-Krzynska A, Sörensson P, Thilén U, Wikström AK, Bay A. Time to childbirth and assisted reproductive treatment in women with congenital heart disease. Open Heart 2024; 11:e002591. [PMID: 38485120 PMCID: PMC10941114 DOI: 10.1136/openhrt-2023-002591] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2024] [Accepted: 03/04/2024] [Indexed: 03/17/2024] Open
Abstract
OBJECTIVE To investigate the time to first childbirth and to compare the prevalence of assisted reproductive treatment (ART) in women with congenital heart disease (CHD) compared with women without CHD. METHODS All women in the national register for CHD who had a registered first childbirth in the Swedish Pregnancy Register between 2014 and 2019 were identified. These individuals (cases) were matched by birth year and municipality to women without CHD (controls) in a 1:5 ratio. The time from the 18th birthday to the first childbirth and the prevalence of ART was compared between cases and controls. RESULTS 830 first childbirths in cases were identified and compared with 4137 controls. Cases were slightly older at the time for first childbirth (28.9 vs 28.5 years, p=0.04) and ART was more common (6.1% vs 4.0%, p<0.01) compared with controls. There were no differences in ART when stratifying for the complexity of CHD. For all women, higher age was associated with ART treatment (OR 1.24, 95% CI 1.20 to 1.28). CONCLUSIONS Women with and without CHD who gave birth to a first child did so at similar ages. ART was more common in women with CHD, but disease severity did not influence the need for ART. Age was an important risk factor for ART also in women with CHD and should be considered in consultations with these patients.
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Affiliation(s)
- Sara Jonsson
- Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
| | | | - Bengt Johansson
- Department of Surgical and Perioperative Sciences, Umeå University, Umeå, Sweden
| | | | | | - Mikael Dellborg
- Department of Clinical and Molecular Medicine, Sahlgrenska Academy, University of Gothenburg, Goteborg, Sweden
| | | | - Peder Sörensson
- Department of Medicine, Solna, Karolinska Institutet, Stockholm, Sweden
- Department of Cardiology, Karolinska University Hospital, Stockholm, Sweden
| | - Ulf Thilén
- Department of Clinical Sciences, Lund University, Lund, Sweden
| | - Anna-Karin Wikström
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
| | - Annika Bay
- Department of Nursing, Umeå University, Umeå, Sweden
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13
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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 2024:1-7. [PMID: 38465638 DOI: 10.1017/s1047951124000374] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [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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14
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Dhiman S, Sharma A, Gupta A, Vatsa R, Bharti J, Kulshrestha V, Yadav S, Dadhwal V, Malhotra N. Fetomaternal outcomes in pregnant women with congenital heart disease: a comparative analysis from an apex institute. Obstet Gynecol Sci 2024; 67:218-226. [PMID: 38356351 PMCID: PMC10948205 DOI: 10.5468/ogs.23264] [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: 11/06/2023] [Revised: 12/28/2023] [Accepted: 01/21/2024] [Indexed: 02/16/2024] Open
Abstract
OBJECTIVE With advancements in cardiac surgical interventions during infancy and childhood, the incidence of maternal congenital heart disease (CHD) is increasing. This retrospective study compared fetal and cardiac outcomes in women with and without CHD, along with a sub-analysis between cyanotic versus non-cyanotic defects and operated versus non-operated cases. METHODS A 10-year data were retrospectively collected from pregnant women with CHD and a 1:1 ratio of pregnant women without any heart disease. Adverse fetal and cardiac outcomes were noted in both groups. Statistical significance was set at P<0.05. RESULTS A total of 86 pregnant women with CHD were studied, with atrial septal defects (29.06%) being the most common. Out of 86 participants, 27 (31.39%) had cyanotic CHD. Around 55% of cases were already operated on for their cardiac defects. Among cardiovascular complications, 5.8% suffered from heart failure, 7.0% had pulmonary arterial hypertension, 8.1% presented in New York Heart Association functional class IV, 9.3% had a need for intensive care unit admission, and one experienced maternal mortality. Adverse fetal outcomes, including operative vaginal delivery, mean duration of hospital stay, fetal growth restriction, preterm birth (<37 weeks), low birth weight (<2,500 g), 5-minute APGAR score <7, and neonatal intensive care unit admissions, were significantly higher in women with CHD than in women without heart disease. CONCLUSION Women with CHD have a higher risk of adverse fetal and cardiac outcomes. The outcome can be improved with proper pre-conceptional optimization of the cardiac condition, good antenatal care, and multidisciplinary team management.
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Affiliation(s)
- Soniya Dhiman
- Department of Obstetrics and Gynaecology, All India Institute of Medical Science, New Delhi,
India
| | - Aparna Sharma
- Department of Obstetrics and Gynaecology, All India Institute of Medical Science, New Delhi,
India
| | - Akanksha Gupta
- Department of Obstetrics and Gynaecology, All India Institute of Medical Science, New Delhi,
India
| | - Richa Vatsa
- Department of Obstetrics and Gynaecology, All India Institute of Medical Science, New Delhi,
India
| | - Juhi Bharti
- Department of Obstetrics and Gynaecology, All India Institute of Medical Science, New Delhi,
India
| | - Vidushi Kulshrestha
- Department of Obstetrics and Gynaecology, All India Institute of Medical Science, New Delhi,
India
| | - Satyavir Yadav
- Department of Cardiology, All India Institute of Medical Science, New Delhi,
India
| | - Vatsla Dadhwal
- Department of Obstetrics and Gynaecology, All India Institute of Medical Science, New Delhi,
India
| | - Neena Malhotra
- Department of Obstetrics and Gynaecology, All India Institute of Medical Science, New Delhi,
India
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15
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Young BT, Baer RJ, Chambers CD, Peyvandi S, Jelliffe-Pawlowski LL, Steurer MA. What drives outcomes in infants of mothers with congenital heart disease? A mediation analysis. J Perinatol 2024; 44:366-372. [PMID: 37857810 PMCID: PMC10920192 DOI: 10.1038/s41372-023-01796-0] [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] [Received: 01/09/2023] [Revised: 09/22/2023] [Accepted: 10/06/2023] [Indexed: 10/21/2023]
Abstract
OBJECTIVE Infants of mothers with adult congenital heart disease (ACHD) are at increased risk for adverse pregnancy and neonatal outcomes. We aim to identify mediators in the relationship between ACHD and pregnancy and infant outcomes. STUDY DESIGN Case-control study using linked maternal and infant hospital records. Structural equation modeling was performed to assess for potential mediators of pregnancy and infant outcomes. RESULT We showed an increased risk of multiple adverse infant and pregnancy outcomes among infants born to mothers with ACHD. Maternal placental syndrome and congestive heart failure were mediators of prematurity. Prematurity and critical congenital heart disease in the infant were mediators of infant outcomes. However, the direct effect of ACHD on outcomes beyond that explained by these mediators remained significant. CONCLUSION While significant mediators of infant and pregnancy outcomes were identified, there was a large direct effect of maternal ACHD. Further studies should aim to identify more factors that explain these infants' vulnerability.
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Affiliation(s)
- Brian T Young
- Department of Pediatrics, University of California San Francisco, San Francisco, CA, US.
- Division of Pediatric Critical Care, Department of Pediatrics, Kaiser Permanente Northern California, Oakland, CA, US.
| | - Rebecca J Baer
- Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, CA, US
- Department of Pediatrics, University of California San Diego, La Jolla, CA, US
| | | | - Shabnam Peyvandi
- Department of Pediatrics, University of California San Francisco, San Francisco, CA, US
- Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, CA, US
| | - Laura L Jelliffe-Pawlowski
- Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, CA, US
| | - Martina A Steurer
- Department of Pediatrics, University of California San Francisco, San Francisco, CA, US
- Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, CA, US
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16
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Afari H, Sheehan M, Reza N. Contemporary Management of Cardiomyopathy and Heart Failure in Pregnancy. Cardiol Ther 2024; 13:17-37. [PMID: 38340291 PMCID: PMC10899150 DOI: 10.1007/s40119-024-00351-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2023] [Accepted: 01/11/2024] [Indexed: 02/12/2024] Open
Abstract
Cardiovascular disease is the primary cause of pregnancy-related mortality and morbidity in the United States, and maternal mortality has increased over the last decade. Pregnancy and the postpartum period are associated with significant vascular, metabolic, and physiologic adaptations that can unmask new heart failure or exacerbate heart failure symptoms in women with known underlying cardiomyopathy. There are unique management considerations for heart failure in women throughout pregnancy, and it is imperative that clinicians caring for pregnant women understand these important principles. Early involvement of multidisciplinary cardio-obstetrics teams is key to optimizing maternal and fetal outcomes. In this review, we discuss the unique challenges and opportunities in the diagnosis of heart failure in pregnancy, management principles along the continuum of pregnancy, and the safety of heart failure therapies during and after pregnancy.
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Affiliation(s)
- Henrietta Afari
- Division of Cardiovascular Medicine, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, 3400 Civic Center Boulevard, 11Th Floor South Pavilion, Philadelphia, PA, 19104, USA
| | - Megan Sheehan
- Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Nosheen Reza
- Division of Cardiovascular Medicine, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, 3400 Civic Center Boulevard, 11Th Floor South Pavilion, Philadelphia, PA, 19104, USA.
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Gnanaraj JP, Anne Princy S. Bridging gaps: The urgent call for cardio-obstetrics as a subspecialty in India. Indian Heart J 2024; 76:71-78. [PMID: 38508307 PMCID: PMC11143512 DOI: 10.1016/j.ihj.2024.03.003] [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] [Received: 11/16/2023] [Revised: 02/26/2024] [Accepted: 03/16/2024] [Indexed: 03/22/2024] Open
Abstract
Cardiovascular disease complicates 1-4% of pregnancies. Women with heart disease going through pregnancy are on the increase. While global maternal deaths during pregnancy are decreasing, India remains a significant contributor to maternal deaths in the world. Cardiovascular disease during pregnancy is the leading cause of maternal mortality in developed nations, and this trend is expected soon in India, with the ongoing obstetric transition. Research in developed nations indicates that a high proportion of maternal mortality related to heart disease is preventable. However, India lacks indigenous data, risk stratification tools, management guidelines, and a well-defined cardio-obstetric team concept for pregnant women with heart disease. There is a pressing need to establish national registries, develop risk stratification tools, develop and disseminate management guidelines, and create dedicated cardio-obstetric programs. This article provides a comprehensive overview of this requirement and offers solutions to bridge the existing gaps in India's maternal healthcare landscape.
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Affiliation(s)
- Justin Paul Gnanaraj
- Institute of Cardiology, Madras Medical College and Rajiv Gandhi Government General Hospital, Park Town, Chennai, 600002, India; The Tamil Nadu Dr MGR Medical University, Guindy, Chennai, 600032, India.
| | - Steaphen Anne Princy
- The Tamil Nadu Dr MGR Medical University, Guindy, Chennai, 600032, India; The Tamil Nadu Government Multi Super Speciality Hospital, Omandurar estate, Chennai, 600003, India
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18
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Hettiarachchi A, Lokunarangoda N, Agampodi T, Agampodi S. Disease burden of cardiovascular conditions complicating pregnancy in Sri Lanka: a protocol. F1000Res 2024; 10:1028. [PMID: 38504849 PMCID: PMC10948970 DOI: 10.12688/f1000research.52539.2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/27/2024] [Indexed: 03/21/2024] Open
Abstract
Background Cardiovascular diseases (CVD) are the commonest indirect medical cause of maternal deaths worldwide, both in high-income and low and middle-income countries. To minimize the effects of CVD in pregnancy, proper risk assessment and appropriate referral is required. In Sri Lanka, cardiovascular disease complicating pregnancy is a significant cause of maternal mortality, second only to postpartum hemorrhage. Screening for CVD in pregnancy in Sri Lanka is limited to a routine clinical assessment. Evidence-based guidelines are yet to be developed, and this deficit may have resulted in a substantial underestimation of the CVD burden. This study aims to determine the burden of CVD in early pregnancy and develop a risk prediction model to be used in field pregnancy clinics in Sri Lanka to reduce CVD effects in pregnancy. Methods A prospective cohort study was carried out in the Anuradhapura district, Sri Lanka. Following registration to the antenatal care, pregnant women fulfilling the eligibility criteria were invited to attend a special clinic at their relevant Medical Officer of Health (MOH) area. Risk assessment was done through history and a clinical examination, and suspected/probable cases were referred for an echocardiogram by a consultant cardiologist. All the recruited participants in the first trimester were prospectively followed up and screened again between 24-28 weeks of the period of amenorrhoea (POA). Antenatal ward admissions with CVD complicating pregnancy will be extracted, and a telephone interview will be carried out between 6-12 weeks after the expected delivery date to cover postpartum morbidities. Discussion This proposed study will be the largest of its kind carried out in the local setting. The study's findings will be beneficial for policymakers to develop guidelines to reduce maternal cardiovascular disease morbidities and mortalities in Sri Lanka.
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Affiliation(s)
- Ayesh Hettiarachchi
- Department of Community Medicine, Faculty of Medicine and Allied Sciences, Rajarata University of Sri Lanka, Saliyapura, Anuradhapura, 5008, Sri Lanka
| | - Niroshan Lokunarangoda
- Department of Medicine, Faculty of Medicine and Allied Sciences, Rajarata University of Sri Lanka, Saliyapura, Anuradhapura, 5008, Sri Lanka
| | - Thilini Agampodi
- Department of Community Medicine, Faculty of Medicine and Allied Sciences, Rajarata University of Sri Lanka, Saliyapura, Anuradhapura, 5008, Sri Lanka
| | - Suneth Agampodi
- Department of Community Medicine, Faculty of Medicine and Allied Sciences, Rajarata University of Sri Lanka, Saliyapura, Anuradhapura, 5008, Sri Lanka
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19
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Choi E, Uribe K, Ipek EG, Vaught A, Gammie JS, Wang H, Minhas AS. Preconception Counseling for a Patient With a Mechanical Tricuspid Valve. JACC Case Rep 2024; 29:102159. [PMID: 38361564 PMCID: PMC10865114 DOI: 10.1016/j.jaccas.2023.102159] [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: 06/12/2023] [Revised: 10/23/2023] [Accepted: 11/09/2023] [Indexed: 02/17/2024]
Abstract
A 37-year-old woman with mechanical tricuspid valve thrombosis presented for preconception consultation. Multimodality imaging confirmed a malfunctioning bileaflet mechanical tricuspid valve with both leaflets fixed and open. This case highlights the key discussions held by the multidisciplinary pregnancy heart team.
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Affiliation(s)
- Eunjung Choi
- Division of Cardiovascular Medicine, Department of Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Katelyn Uribe
- Division of Maternal Fetal Medicine, Department of Gynecology and Obstetrics, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Esra Gucuk Ipek
- Heart and Vascular Center, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Arthur Vaught
- Division of Maternal Fetal Medicine, Department of Gynecology and Obstetrics, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - James S. Gammie
- Division of Cardiac Surgery, Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Hanghang Wang
- Division of Cardiac Surgery, Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Anum S. Minhas
- Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
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20
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Sarma AA, Lau ES, Sharma G, King LP, Economy KE, Wood R, Wood MJ, Feinberg L, Isselbacher EM, Hameed AB, DeFaria Yeh D, Scott NS. Maternal Cardiovascular Health Post-Dobbs. NEJM EVIDENCE 2024; 3:EVIDra2300273. [PMID: 38320493 DOI: 10.1056/evidra2300273] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/08/2024]
Abstract
Maternal Cardiovascular Health Post-DobbsPregnancy is associated with increasing morbidity and mortality in the United States. In the post-Dobbs era, many pregnant patients at highest risk no longer have access to abortion, which has been a crucial component of standard medical care.
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Affiliation(s)
- Amy A Sarma
- Division of Cardiology, Massachusetts General Hospital, Boston
| | - Emily S Lau
- Division of Cardiology, Massachusetts General Hospital, Boston
| | - Garima Sharma
- Inova Schar Heart and Vascular, Inova Health System, Falls Church, VA
| | - Louise P King
- Division of Obstetrics and Gynecology, Brigham and Women's Hospital, Boston
| | | | - Rachel Wood
- Division of Obstetrics and Gynecology, Brigham and Women's Hospital, Boston
| | | | - Loryn Feinberg
- Division of Cardiology, Beth Israel Deaconess Medical Center, Boston
| | | | | | | | - Nandita S Scott
- Division of Cardiology, Massachusetts General Hospital, Boston
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21
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Rosenthal E, Guerrero K, Gupta M, Kuba K, Wolfe DS. A Complex Adult Congenital Heart Disease Case in Pregnancy: A Multidisciplinary Approach. JACC Case Rep 2024; 29:102170. [PMID: 38264306 PMCID: PMC10801841 DOI: 10.1016/j.jaccas.2023.102170] [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: 09/08/2023] [Accepted: 10/17/2023] [Indexed: 01/25/2024]
Abstract
Multidisciplinary teams decrease the likelihood of adverse pregnancy outcomes in high-risk pregnant cardiac patients. We present the case of a patient with complex congenital heart disease and a mechanical mitral valve, whose treatment included warfarin until delivery despite the discovery of placental hematomas. A multidisciplinary approach mitigated both maternal and fetal adverse pregnancy outcomes.
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Affiliation(s)
- Elise Rosenthal
- Department of Obstetrics and Gynecology, Division of Maternal Fetal Medicine, UT Southwestern Medical Center, Dallas, Texas, USA
| | - Kerly Guerrero
- Department of Obstetrics and Gynecology, Division of Maternal Fetal Medicine, Montefiore Medical Center and Albert Einstein College of Medicine, Bronx, New York, USA
| | - Manoj Gupta
- Department of Pediatric Cardiology, Children’s Hospital at Montefiore and Albert Einstein College of Medicine, Bronx, New York, USA
| | - Kfier Kuba
- Department of Obstetrics and Gynecology, Division of Maternal Fetal Medicine, Long Island Jewish Medical Center–Northwell Health, New Hyde Park, New York, USA
| | - Diana S. Wolfe
- Department of Obstetrics and Gynecology, Division of Maternal Fetal Medicine, Montefiore Medical Center and Albert Einstein College of Medicine, Bronx, New York, USA
- Maternal Fetal Medicine Cardiology Joint Program, Montefiore Medical Center and Albert Einstein College of Medicine, Bronx, New York, USA
- Department of Medicine, Cardiology, Montefiore Medical Center and Albert Einstein College of Medicine, Bronx, New York, USA
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22
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Chandra NV, Stroud S, Kamath MY. Case Implementing 2022 AHA/ACC/HFSA Guidelines: Heart Failure Management in Pregnancy: Early Planning, Close Surveillance, and Multidisciplinary Care. Circ Heart Fail 2024; 17:e010580. [PMID: 38088175 DOI: 10.1161/circheartfailure.123.010580] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/18/2024]
Affiliation(s)
- Neha V Chandra
- Division of Cardiology, Department of Medicine, University of California, Los Angeles (N.V.C., M.Y.K.)
| | - Steven Stroud
- Advanced Heart Failure Center, Department of Cardiology, Oklahoma Heart Institute, Tulsa (S.S.)
| | - Megan Y Kamath
- Division of Cardiology, Department of Medicine, University of California, Los Angeles (N.V.C., M.Y.K.)
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23
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Fernandez-Campos B, Colman JM. Stress Echocardiography for Prepregnancy Counselling… Ready for Prime Time? Can J Cardiol 2024; 40:128-129. [PMID: 37863390 DOI: 10.1016/j.cjca.2023.10.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2023] [Accepted: 10/11/2023] [Indexed: 10/22/2023] Open
Affiliation(s)
- Beatriz Fernandez-Campos
- Toronto ACHD Program and University of Toronto Program in Cardio-Obstetrics, Mount Sinai and Toronto General Hospitals, Toronto, Ontario, Canada
| | - Jack M Colman
- Toronto ACHD Program and University of Toronto Program in Cardio-Obstetrics, Mount Sinai and Toronto General Hospitals, Toronto, Ontario, Canada.
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24
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Kornacki J, Olejniczak O, Sibiak R, Gutaj P, Wender-Ożegowska E. Pathophysiology of Pre-Eclampsia-Two Theories of the Development of the Disease. Int J Mol Sci 2023; 25:307. [PMID: 38203478 PMCID: PMC10779413 DOI: 10.3390/ijms25010307] [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] [Received: 11/23/2023] [Revised: 12/20/2023] [Accepted: 12/21/2023] [Indexed: 01/12/2024] Open
Abstract
Pre-eclampsia (PE) continues to be a leading cause of maternal and fetal mortality and morbidity. While substantial progress has been made in understanding the pathomechanisms of PE, the pathophysiology of the disease is still not fully understood. While the "two-stage model" of the development of PE is the most widely accepted theory, stating that the placenta is the main source of the disease, there are some other pathophysiological models of PE. Among these other theories, the one considering heart dysfunction as serving as the primary cause of PE seems to be gaining increasing prominence. In this review, we aim to elucidate these two divergent concepts concerning the development of PE. Despite some differences in their proposed pathomechanisms, both theories share vital pathophysiological elements in common. A central and critical component in both models is impaired placental perfusion, which appears to be a crucial phenomenon in PE. A comprehensive understanding of the different pathomechanisms involved in PE may be helpful in clinical practice, prompting a more individual approach to care of patients with PE.
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Affiliation(s)
- Jakub Kornacki
- Department of Reproduction, Chair of Reproduction and Perinatal Medicine, Poznan University of Medical Sciences, 61-701 Poznan, Poland; (O.O.); (R.S.); (P.G.); (E.W.-O.)
| | - Olga Olejniczak
- Department of Reproduction, Chair of Reproduction and Perinatal Medicine, Poznan University of Medical Sciences, 61-701 Poznan, Poland; (O.O.); (R.S.); (P.G.); (E.W.-O.)
| | - Rafał Sibiak
- Department of Reproduction, Chair of Reproduction and Perinatal Medicine, Poznan University of Medical Sciences, 61-701 Poznan, Poland; (O.O.); (R.S.); (P.G.); (E.W.-O.)
- Department of Histology and Embryology, Poznan University of Medical Sciences, 60-701 Poznan, Poland
- Doctoral School, Poznan University of Medical Sciences, 60-701 Poznan, Poland
| | - Paweł Gutaj
- Department of Reproduction, Chair of Reproduction and Perinatal Medicine, Poznan University of Medical Sciences, 61-701 Poznan, Poland; (O.O.); (R.S.); (P.G.); (E.W.-O.)
| | - Ewa Wender-Ożegowska
- Department of Reproduction, Chair of Reproduction and Perinatal Medicine, Poznan University of Medical Sciences, 61-701 Poznan, Poland; (O.O.); (R.S.); (P.G.); (E.W.-O.)
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25
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Vinsard PA, Arendt KW, Sharpe EE. Care for the Obstetric Patient with Complex Cardiac Disease. Adv Anesth 2023; 41:53-69. [PMID: 38251622 DOI: 10.1016/j.aan.2023.05.004] [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: 01/23/2024]
Abstract
The prevalence of cardiac disease-related maternal morbidity and mortality is on the rise in the United States. To ensure safe management of pregnancy in patients with cardiovascular disease, pre-delivery evaluation by a multidisciplinary Pregnancy Heart Team should occur. Appropriate anesthetic, cardiac, and obstetric care are essential. Risk stratification tools evaluate the etiology and severity of cardiovascular disease to determine the appropriate hospital type and location for delivery and anesthetic management. Intrapartum hemodynamic monitoring may need to be intensified, and neuraxial analgesia and anesthesia are generally appropriate. The anesthesiologist must be prepared for obstetric and cardiac emergencies.
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Affiliation(s)
- Patrice A Vinsard
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, 200 First Street Southwest, Rochester, MN 55905, USA
| | - Katherine W Arendt
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, 200 First Street Southwest, Rochester, MN 55905, USA
| | - Emily E Sharpe
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, 200 First Street Southwest, Rochester, MN 55905, USA.
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26
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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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27
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Allen-Davis W, Hylton M, Gibson S, Rattray C, Johnson N, Hunter TA. Pregnancy outcomes of women with cardiac disease. Int J Gynaecol Obstet 2023; 163:1005-1011. [PMID: 37697807 DOI: 10.1002/ijgo.15068] [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] [Received: 02/28/2023] [Revised: 08/05/2023] [Accepted: 08/17/2023] [Indexed: 09/13/2023]
Abstract
OBJECTIVE To determine and predict the maternal and neonatal outcomes of pregnancies occurring in patients with cardiac disease. METHOD This retrospective review included 147 pregnancies identified from antenatal, delivery, and nursery records. Information concerning the nature and severity of the pre-existing cardiac disease, comorbidities, risk scores, obstetric or cardiac complications, and pregnancy outcomes were collected. The data were analyzed using SPSS Windows version 22. RESULTS In all, 111 (73.5%) of the cohort had acquired heart disease and 4 (2.7%) of patients belonged to WHO class IV, in which pregnancy is not recommended. Additionally, 12 (8.1%) were categorized as being at significant risk of having a cardiac complication. The proportion of patients that had maternal and perinatal mortality was 6 (4.0%) and 7 (4.8%), respectively. The WHO and CARPREG scoring systems were reliably able to predict cardiac events (P < 0.01). Mothers who received preconception counseling had significantly fewer occurrences of cardiac and obstetric events than those who did not. CONCLUSION Cardiac disease in pregnancy in women managed at our center was most often an acquired disease. The baseline risk assessment scores accurately predicted the likelihood of adverse cardiac outcomes.
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Affiliation(s)
- Wendy Allen-Davis
- Department of Obstetrics and Gynaecology, University of the West Indies, Kingston, Jamaica
| | - Melesia Hylton
- Department of Obstetrics and Gynaecology, University of the West Indies, Kingston, Jamaica
| | - Shanea Gibson
- Department of Obstetrics and Gynaecology, University of the West Indies, Kingston, Jamaica
| | - Carole Rattray
- Department of Obstetrics and Gynaecology, University of the West Indies, Kingston, Jamaica
| | - Nadine Johnson
- Department of Obstetrics and Gynaecology, University of the West Indies, Kingston, Jamaica
| | - Tiffany A Hunter
- Department of Obstetrics and Gynaecology, University of the West Indies, Kingston, Jamaica
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28
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Garagiola ML, Thorne SA. Pregnancy Considerations in Tetralogy of Fallot. CJC PEDIATRIC AND CONGENITAL HEART DISEASE 2023; 2:301-313. [PMID: 38161671 PMCID: PMC10755828 DOI: 10.1016/j.cjcpc.2023.09.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/03/2023] [Accepted: 09/12/2023] [Indexed: 01/03/2024]
Abstract
The majority of women with repaired tetralogy of Fallot are able to tolerate pregnancy with a low risk of cardiovascular events. However, proactive contraceptive advice, prepregnancy counselling, and care by a pregnancy heart team with expertise in congenital heart disease are key to ensuring a good outcome for mother and baby. Maternal and fetal risks are increased in the presence of severe valvular stenosis, poorly tolerated arrhythmia, significant ventricular dysfunction, and cyanosis. It is unusual to see cyanotic adults with tetralogy of Fallot, whether unoperated or shunt palliated; pregnancy risks are greatly reduced by completing their repair before pregnancy is undertaken. The multidisciplinary pregnancy heart team should make a risk-stratified pregnancy care plan using a combination of published scoring systems and an individualized assessment of the patient's comorbidities. Low-risk patients may have the majority of their care and give birth in local units, whereas those at high risk should be managed and give birth in a tertiary centre with high-level expertise and intensive care facilities. Age-appropriate conversations about future childbearing and safe and reliable contraception should be part of routine follow-up from teenage years, so that women with tetralogy of Fallot can control their own fertility and make informed decisions about having children.
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Affiliation(s)
- Maria L. Garagiola
- Division of Cardiology, University Health Network and Mount Sinai Health System, University of Toronto, Toronto, Ontario, Canada
| | - Sara A. Thorne
- Division of Cardiology, University Health Network and Mount Sinai Health System, University of Toronto, Toronto, Ontario, Canada
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29
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Sharma G, Mehta A, Scott NS. Risk Estimation in Valvular Heart Disease in Pregnancy: An Idea Whose Time Has Come. J Am Coll Cardiol 2023; 82:1407-1410. [PMID: 37758435 DOI: 10.1016/j.jacc.2023.08.022] [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: 08/11/2023] [Accepted: 08/14/2023] [Indexed: 10/03/2023]
Affiliation(s)
- Garima Sharma
- Inova Schar Heart and Vascular, Inova Health System, Falls Church, Virginia, USA.
| | - Aditya Mehta
- Inova Schar Heart and Vascular, Inova Health System, Falls Church, Virginia, USA
| | - Nandita S Scott
- Division of Cardiology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
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30
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Joglar JA, Kapa S, Saarel EV, Dubin AM, Gorenek B, Hameed AB, Lara de Melo S, Leal MA, Mondésert B, Pacheco LD, Robinson MR, Sarkozy A, Silversides CK, Spears D, Srinivas SK, Strasburger JF, Tedrow UB, Wright JM, Zelop CM, Zentner D. 2023 HRS expert consensus statement on the management of arrhythmias during pregnancy. Heart Rhythm 2023; 20:e175-e264. [PMID: 37211147 DOI: 10.1016/j.hrthm.2023.05.017] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2023] [Accepted: 05/12/2023] [Indexed: 05/23/2023]
Abstract
This international multidisciplinary expert consensus statement is intended to provide comprehensive guidance that can be referenced at the point of care to cardiac electrophysiologists, cardiologists, and other health care professionals, on the management of cardiac arrhythmias in pregnant patients and in fetuses. This document covers general concepts related to arrhythmias, including both brady- and tachyarrhythmias, in both the patient and the fetus during pregnancy. Recommendations are provided for optimal approaches to diagnosis and evaluation of arrhythmias; selection of invasive and noninvasive options for treatment of arrhythmias; and disease- and patient-specific considerations when risk stratifying, diagnosing, and treating arrhythmias in pregnant patients and fetuses. Gaps in knowledge and new directions for future research are also identified.
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Affiliation(s)
- José A Joglar
- The University of Texas Southwestern Medical Center, Dallas, Texas
| | | | - Elizabeth V Saarel
- St. Luke's Health System, Boise, Idaho, and Cleveland Clinic Lerner College of Medicine at Case Western Reserve University, Cleveland, Ohio
| | | | | | | | | | | | | | - Luis D Pacheco
- The University of Texas Medical Branch at Galveston, Galveston, Texas
| | | | - Andrea Sarkozy
- University Hospital of Antwerp, University of Antwerp, Antwerp, Belgium
| | | | - Danna Spears
- University Health Network, Toronto, Ontario, Canada
| | - Sindhu K Srinivas
- University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
| | | | | | | | - Carolyn M Zelop
- The Valley Health System, Ridgewood, New Jersey; New York University Grossman School of Medicine, New York, New York
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31
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Schultz H, Sobhani NC, Blissett S, Yogeswaran V, Hong J, Harris IS, Parikh N, Gonzalez J, Agarwal A. Cardiovascular events more than 6 months after pregnancy in patients with congenital heart disease. Open Heart 2023; 10:e002430. [PMID: 37709299 PMCID: PMC10503351 DOI: 10.1136/openhrt-2023-002430] [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] [Received: 07/22/2023] [Accepted: 08/08/2023] [Indexed: 09/16/2023] Open
Abstract
OBJECTIVES Patients with congenital heart disease (CHD) are increasingly pursuing pregnancy, highlighting the need for data on late cardiovascular events (more than 6 months after delivery). We aimed to determine the incidence of late cardiovascular events in postpartum patients with CHD and evaluate the accuracy of the existing risk scores in predicting these events. STUDY DESIGN We identified patients with CHD who delivered between 2008 and 2020 at a tertiary centre and had follow-up data for greater than 6 months post partum. Late cardiovascular events were defined as heart failure, arrhythmia, thromboembolic events, endocarditis, urgent cardiovascular interventions or death. Survival analysis and Cox proportional model were used to estimate the incidence of late cardiovascular events and determine the hazard ratio of factors associated with these events. RESULTS Of 117 patients, 19% had 36 late cardiovascular events over a median follow-up of 3.8 years. Annual incidence of any late cardiovascular event was 5.7%. Hazards of late cardiovascular events were significantly higher among those with higher Cardiac Disease in Pregnancy Study (CARPREG) II and Zwangerschap bij Aangeboren HARtAfwijking-Pregnancy in Women With Congenital Heart Disease (ZAHARA) risk scores and among patients with prepregnancy New York Heart Association class≥II. C-statistic to predict the late cardiovascular events was highest for ZAHARA (0.7823), followed by CARPREG II (0.6902) and prepregnancy New York Heart Association class≥ II (0.6677). CONCLUSIONS Currently available risk tools designed for prognostication during the peripartum period can also be used to determine risks of late maternal cardiovascular events among those with CHD. These findings provide important new information for counselling and risk modification.
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Affiliation(s)
- Hayley Schultz
- School of Medicine, University of California, San Francisco, California, USA
- Obstetrics, Gynecology, and Reproductive Sciences, University of California, San Diego, La Jolla, California, USA
| | - Nasim C Sobhani
- Obstetrics, Gynecology, and Reproductive Sciences, University of California, San Francisco, California, USA
| | - Sarah Blissett
- Obstetrics, Gynecology, and Reproductive Sciences, University of California, San Francisco, California, USA
- Department of Medicine, Division of Cardiology, Western University, London, Ontario, Canada
| | - Vidhushei Yogeswaran
- Division of Cardiology, University of Washington Medical Center, Seattle, Washington, USA
| | - Jessica Hong
- Obstetrics, Gynecology, and Reproductive Sciences, University of California, San Francisco, California, USA
| | - Ian S Harris
- Obstetrics, Gynecology, and Reproductive Sciences, University of California, San Francisco, California, USA
| | - Nisha Parikh
- Department of Medicine, Division of Cardiology, University of California, San Francisco, California, USA
| | - Juan Gonzalez
- Obstetrics, Gynecology, and Reproductive Sciences, University of California, San Francisco, California, USA
| | - Anushree Agarwal
- Cardiology, University of California, San Francisco, California, USA
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32
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Misra A, Porras MP, Rajendran A, Contreras J, Scott NS. Cardio-Obstetrics: A Focused Review. Curr Cardiol Rep 2023; 25:1065-1073. [PMID: 37540401 DOI: 10.1007/s11886-023-01928-0] [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] [Accepted: 07/18/2023] [Indexed: 08/05/2023]
Abstract
PURPOSE OF REVIEW Cardiovascular disease is the leading cause of maternal mortality in the USA. All cardiovascular care providers should have a foundational knowledge on the management of pregnant individuals with heart disease. This focused review touches on several key cardio-obstetric themes. RECENT FINDINGS Many individuals with cardiovascular disease can safely undergo pregnancy, but should have counseling preconception to optimize cardiac status. There are several cardiovascular conditions that are high risk for maternal mortality and morbidity. These individuals should be adequately counseled preconception and offered reliable birth control. The approach to a high-risk pregnant patient with cardiac disease is best managed by a multidisciplinary team to address potential maternal and fetal complications. Identification of at risk individuals can be estimated preconception with several risk scores. The development of risk scores to stratify and identify those at elevated risk during pregnancy is an area of continued research and development.
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Affiliation(s)
- Amrit Misra
- Department of Cardiology, Brigham and Women's Hospital, Boston, MA, USA
| | | | - Aardra Rajendran
- Department of Internal Medicine, John Hopkins University, Baltimore, MD, USA
| | - Johanna Contreras
- Department of Cardiology, Division of Advanced Heart Failure and Transplant, Icahn School of Medicine, Mount Sinai, New York City, NY, USA
| | - Nandita S Scott
- Division of Cardiology, Department of Medicine, Massachusetts General Hospital, 55 Fruit Street, Yawkey 5B, Boston, MA, 02114, USA.
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33
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Venkatesh P, Lin JP, Nguyen A, Rezkalla J, Moore JP. Predictors of arrhythmia during pregnancy in adults with congenital heart disease. Int J Cardiol 2023; 386:37-44. [PMID: 37178799 DOI: 10.1016/j.ijcard.2023.05.015] [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] [Received: 02/12/2023] [Revised: 04/24/2023] [Accepted: 05/10/2023] [Indexed: 05/15/2023]
Abstract
BACKGROUND Risk prediction of arrhythmia during pregnancy in adult congenital heart disease (ACHD) patients is currently lacking, and the impact of preconception catheter ablation on future antepartum arrhythmia has not been studied. METHODS We conducted a single-center, retrospective cohort study of pregnancies in ACHD patients. Clinically significant arrhythmia events during pregnancy were described, predictors of arrhythmia were analyzed, and a risk score devised. The impact of preconception catheter ablation on antepartum arrhythmia was assessed. RESULTS The study included 172 pregnancies in 137 patients. Arrhythmia events occurred in 25 (15%) of pregnancies, with 64% of events occurring in the second trimester and sustained supraventricular tachycardia being the most common rhythm. Univariate predictors of arrhythmia were history of tachyarrhythmia (OR 20.33, 95% CI 6.95-59.47, p < 0.001, Fontan circulation (OR 11.90, 95% CI 2.60-53.70, p < 0.001), baseline physiologic class C/D (OR 3.72, 95% CI 1.54-9.01, p = 0.002) and history of multiple valve interventions (OR 3.10, 95% CI 1.20-8.20, p = 0.017). Three risk factors (excluding multiple valve interventions) were used to formulate a risk score, with a cutoff of ≥2 points predicting antepartum arrhythmia with sensitivity and specificity of 84%. While recurrence of the index arrhythmia was not observed following successful catheter ablation, preconception ablation did not impact odds of antepartum arrhythmia. CONCLUSIONS We provide a novel risk stratification scheme for predicting antepartum arrhythmia in ACHD patients. The role of contemporary preconception catheter ablation in risk reduction needs further refinement with multicenter investigation.
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Affiliation(s)
- Prashanth Venkatesh
- Department of Cardiology, Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA, United States of America.
| | - Jeannette P Lin
- Ahmanson/UCLA Adult Congenital Heart Disease Center, Department of Medicine, University of California, Los Angeles, Los Angeles, CA, United States of America; UCLA Cardio-Obstetrics Program, Department of Medicine, University of California, Los Angeles, Los Angeles, CA, United States of America
| | - Amanda Nguyen
- David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, United States of America
| | - Joshua Rezkalla
- Department of Cardiology, Mayo Clinic, Rochester, MN, United States of America
| | - Jeremy P Moore
- Ahmanson/UCLA Adult Congenital Heart Disease Center, Department of Medicine, University of California, Los Angeles, Los Angeles, CA, United States of America; UCLA Cardiac Arrhythmia Center, Department of Medicine, University of California, Los Angeles, Los Angeles, CA, United States of America
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Abdurrahman L. Women with congenital heart disease: Maternal and neonatal health. Curr Probl Pediatr Adolesc Health Care 2023:101398. [PMID: 37479598 DOI: 10.1016/j.cppeds.2023.101398] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/23/2023]
Affiliation(s)
- Lubabatu Abdurrahman
- Chief, Division of Cardiology, Dayton Children's Hospital, One Children's Plaza, Clinical Assistant Professor, Pediatrics, Wright State University, Boonshoft School of Medicine, Dayton, Ohio, 45404, USA.
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González-Vanegas O, Martinez-Perez O. SARS-CoV-2 Infection and Preeclampsia-How an Infection Can Help Us to Know More about an Obstetric Condition. Viruses 2023; 15:1564. [PMID: 37515250 PMCID: PMC10385171 DOI: 10.3390/v15071564] [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: 04/30/2023] [Revised: 06/25/2023] [Accepted: 07/12/2023] [Indexed: 07/30/2023] Open
Abstract
Pregnant women with SARS-CoV-2 infection have a significantly higher risk of maternal death, ICU admission, preterm delivery, and stillbirth compared to those without infection. Additionally, the risk of preeclampsia (PE) increases in pregnant women infected with SARS-CoV-2, particularly in severe cases. The association between COVID-19 and PE is likely attributed to various mechanisms, including direct effects of the virus on trophoblast function and the arterial wall, exaggerated inflammatory response in pregnant women, local inflammation leading to placental ischemia, SARS-CoV-2-related myocardial injury, cytokine storm, and thrombotic microangiopathy. This paper aims to explore the similarities between PE and SARS-CoV-2 infection, considering COVID-19 as a valuable study model. By examining these parallels, we can enhance our knowledge and comprehension of PE. We wish to emphasize the potential for COVID-19-induced myocardial injury in pregnant women and its connection to the increased maternal mortality rate.
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Affiliation(s)
| | - Oscar Martinez-Perez
- Obstetric Departament, Hospital Universitario Puerta de Hierro 2, 28222 Majadahonda, Spain
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Lopian M, Kashani-Ligumsky L, Many A. A Balancing Act: Navigating Hypertensive Disorders of Pregnancy at Very Advanced Maternal Age, from Preconception to Postpartum. J Clin Med 2023; 12:4701. [PMID: 37510816 PMCID: PMC10380965 DOI: 10.3390/jcm12144701] [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: 04/21/2023] [Revised: 05/31/2023] [Accepted: 07/12/2023] [Indexed: 07/30/2023] Open
Abstract
The decision to postpone parenting has gained momentum in recent years, a shift driven by evolving social dynamics and improved access to fertility treatments. Despite their increasing prevalence, pregnancies at advanced maternal ages are associated with increased risks of adverse maternal and neonatal outcomes. This article addresses the association between advanced maternal age and hypertensive disorders of pregnancies (HDPs), which are more prevalent and a significant cause of maternal morbidity and mortality in this population. This review explores the biological mechanisms and age-related risk factors that underpin this increased susceptibility and offers practical management strategies that can be implemented prior to, as well as during, each stage of pregnancy to mitigate the incidence and severity of HDPs in this group. Lastly, this review acknowledges both the short-term and long-term postpartum implications of HDPs in women of advanced maternal age.
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Affiliation(s)
- Miriam Lopian
- Department of Obstetrics and Gynecology, Mayanei Hayeshua Medical Center, Bnei Brak 51544, Israel
- Sackler School of Medicine, Tel Aviv University, Tel Aviv 69978, Israel
| | - Lior Kashani-Ligumsky
- Department of Obstetrics and Gynecology, Mayanei Hayeshua Medical Center, Bnei Brak 51544, Israel
- Sackler School of Medicine, Tel Aviv University, Tel Aviv 69978, Israel
| | - Ariel Many
- Department of Obstetrics and Gynecology, Mayanei Hayeshua Medical Center, Bnei Brak 51544, Israel
- Sackler School of Medicine, Tel Aviv University, Tel Aviv 69978, Israel
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37
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Wander G, van der Zande JA, Patel RR, Johnson MR, Roos-Hesselink J. Pregnancy in women with congenital heart disease: a focus on management and preventing the risk of complications. Expert Rev Cardiovasc Ther 2023; 21:587-599. [PMID: 37470417 DOI: 10.1080/14779072.2023.2237886] [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] [Received: 04/14/2023] [Accepted: 07/14/2023] [Indexed: 07/21/2023]
Abstract
INTRODUCTION Congenital heart disease (CHD) is the most common cardiac disorder in pregnancy in the western world (around 80%). Due to improvements in surgical interventions more women with CHD are surviving to adulthood and choosing to become pregnant. AREAS COVERED Preconception counseling, antenatal management of CHDs and strategies to prevent maternal and fetal complications.Preconception counseling should start early, before the transition to adult care and be offered to both men and women. It should include the choice of contraception, lifestyle modifications, pre-pregnancy optimization of cardiac state, the chance of the child inheriting a similar cardiac lesion, the risks to the mother, and long-term prognosis. Pregnancy induces marked physiological changes in the cardiovascular system that may precipitate cardiac complications. Risk stratification is based on the underlying cardiac disease and data from studies including CARPREG, ZAHARA, and ROPAC. EXPERT OPINION Women with left to right shunts, regurgitant lesions, and most corrected CHDs are at lower risk and can be managed in secondary care. Complex CHD, including systemic right ventricle need expert counseling in a tertiary center. Those with severe stenotic lesions, pulmonary artery hypertension, and Eisenmenger's syndrome should avoid pregnancy, be given effective contraception and managed in a tertiary center if pregnancy does happen.
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Affiliation(s)
- Gurleen Wander
- Imperial College London, Chelsea and Westminster Hospital, London, UK
| | - Johanna A van der Zande
- Department of Cardiology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Roshni R Patel
- Imperial College London, Chelsea and Westminster Hospital, London, UK
| | - Mark R Johnson
- Imperial College London, Chelsea and Westminster Hospital, London, UK
| | - Jolien Roos-Hesselink
- Department of Cardiology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
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Sokou R, Parastatidou S, Iliodromiti Z, Lampropoulou K, Vrachnis D, Boutsikou T, Konstantinidi A, Iacovidou N. Knowledge Gaps and Current Evidence Regarding Breastfeeding Issues in Mothers with Chronic Diseases. Nutrients 2023; 15:2822. [PMID: 37447149 DOI: 10.3390/nu15132822] [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: 05/24/2023] [Revised: 06/16/2023] [Accepted: 06/19/2023] [Indexed: 07/15/2023] Open
Abstract
The prevalence of chronic maternal disease is rising in the last decades in the developed world. Recent evidence indicated that the incidence of chronic maternal disease ranges from 10 to 30% of pregnancies worldwide. Several epidemiological studies in mothers with chronic diseases have mainly focused on the risk for adverse obstetric outcomes. Evidence from these studies supports a correlation between maternal chronic conditions and adverse perinatal outcomes, including increased risk for preeclampsia, cesarean section, preterm birth, and admission in the Neonatal Intensive Care Unit (NICU). However, there is a knowledge gap pertaining to the management of these women during lactation. This review aimed at summarizing the available research literature regarding breastfeeding in mothers with chronic diseases. Adjusted and evidence-based support may be required to promote breastfeeding in women with chronic diseases; however, our comprehension of breastfeeding in this subpopulation is still unclear. The literature related to breastfeeding extends in various scientific areas and multidisciplinary effort is necessary to compile an overview of current evidence and knowledge regarding breastfeeding issues in mothers with chronic diseases.
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Affiliation(s)
- Rozeta Sokou
- Neonatal Intensive Care Unit, "Agios Panteleimon" General Hospital of Nikea, 3 D.Mantouvalou Str., Nikea, 18454 Piraeus, Greece
- Neonatal Department, School of Medicine, National and Kapodistrian University of Athens, Aretaieio Hospital, 11528 Athens, Greece
| | - Stavroula Parastatidou
- Neonatal Intensive Care Unit, "Elena Venizelou" Maternity Hospital, 11521 Athens, Greece
| | - Zoi Iliodromiti
- Neonatal Department, School of Medicine, National and Kapodistrian University of Athens, Aretaieio Hospital, 11528 Athens, Greece
| | - Katerina Lampropoulou
- Neonatal Intensive Care Unit, School of Medicine, University of Ioannina, 45110 Ioannina, Greece
| | - Dionysios Vrachnis
- Endocrinology Unit, 2nd Department of Obstetrics and Gynecology, School of Medicine, National and Kapodistrian University of Athens, Aretaieio Hospital, 11528 Athens, Greece
| | - Theodora Boutsikou
- Neonatal Department, School of Medicine, National and Kapodistrian University of Athens, Aretaieio Hospital, 11528 Athens, Greece
| | - Aikaterini Konstantinidi
- Neonatal Intensive Care Unit, "Agios Panteleimon" General Hospital of Nikea, 3 D.Mantouvalou Str., Nikea, 18454 Piraeus, Greece
| | - Nicoletta Iacovidou
- Neonatal Department, School of Medicine, National and Kapodistrian University of Athens, Aretaieio Hospital, 11528 Athens, Greece
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Ng AP, Verma A, Sanaiha Y, Williamson CG, Afshar Y, Benharash P. Maternal and Fetal Outcomes in Pregnant Patients With Mechanical and Bioprosthetic Heart Valves. J Am Heart Assoc 2023; 12:e028653. [PMID: 37183876 DOI: 10.1161/jaha.122.028653] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/16/2023]
Abstract
Background Guidelines for choice of prosthetic heart valve in people of reproductive age are not well established. Although biologic heart valves (BHVs) have risk of deterioration, mechanical heart valves (MHVs) require lifelong anticoagulation. This study aimed to characterize the association of prosthetic valve type with maternal and fetal outcomes in pregnant patients. Methods and Results Using the 2008 to 2019 National Inpatient Sample, we identified all adult patients hospitalized for delivery with prior heart valve implantation. Multivariable regressions were used to analyze the primary outcome, major adverse cardiovascular events, and secondary outcomes, including maternal and fetal complications, length of stay, and costs. Among 39 871 862 birth hospitalizations, 4152 had MHVs and 874 had BHVs. Age, comorbidities, and cesarean birth rates were similar between patients with MHVs and BHVs. The presence of a prosthetic valve was associated with over 22-fold increase in likelihood of major adverse cardiovascular events (MHV: adjusted odds ratio, 22.1 [95% CI, 17.3-28.2]; BHV: adjusted odds ratio, 22.5 [95% CI, 13.9-36.5]) as well as increased duration of stay and hospitalization costs. However, patients with MHVs and BHVs had no significant difference in the odds of any maternal outcome, including major adverse cardiovascular events, hypertensive disease of pregnancy, and ante/postpartum hemorrhage. Similarly, fetal complications were more likely in patients with valve prostheses, including a 4-fold increase in odds of stillbirth, but remained comparable between MHVs and BHVs. Conclusions Patients hospitalized for delivery with prior valve replacement carry substantial risk of adverse maternal and fetal events, regardless of valve type. Our findings reveal comparable outcomes between MHVs and BHVs.
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Affiliation(s)
- Ayesha P Ng
- Cardiovascular Outcomes Research Laboratories (CORELAB), Division of Cardiac Surgery David Geffen School of Medicine at UCLA Los Angeles CA USA
| | - Arjun Verma
- Cardiovascular Outcomes Research Laboratories (CORELAB), Division of Cardiac Surgery David Geffen School of Medicine at UCLA Los Angeles CA USA
| | - Yas Sanaiha
- Cardiovascular Outcomes Research Laboratories (CORELAB), Division of Cardiac Surgery David Geffen School of Medicine at UCLA Los Angeles CA USA
| | - Catherine G Williamson
- Cardiovascular Outcomes Research Laboratories (CORELAB), Division of Cardiac Surgery David Geffen School of Medicine at UCLA Los Angeles CA USA
| | - Yalda Afshar
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology David Geffen School of Medicine at UCLA Los Angeles CA USA
- Molecular Biology Insitute University of California Los Angeles CA USA
| | - Peyman Benharash
- Cardiovascular Outcomes Research Laboratories (CORELAB), Division of Cardiac Surgery David Geffen School of Medicine at UCLA Los Angeles CA USA
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Halpern DG, Penfield CA, Feinberg JL, Small AJ. Reproductive Health in Congenital Heart Disease: Preconception, Pregnancy, and Postpartum. J Cardiovasc Dev Dis 2023; 10:jcdd10050186. [PMID: 37233153 DOI: 10.3390/jcdd10050186] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2023] [Revised: 04/20/2023] [Accepted: 04/21/2023] [Indexed: 05/27/2023] Open
Abstract
The prevalence of congenital heart disease (CHD) in pregnancy is rising due to the improved survival of patients with CHD into childbearing age. The profound physiological changes that occur during pregnancy may worsen or unmask CHD, affecting both mother and fetus. Successful management of CHD during pregnancy requires knowledge of both the physiological changes of pregnancy and the potential complications of congenital heart lesions. Care of the CHD patient should be based on a multidisciplinary team approach beginning with preconception counseling and continuing into conception, pregnancy, and postpartum periods. This review summarizes the published data, available guidelines and recommendations for the care of CHD during pregnancy.
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Affiliation(s)
- Dan G Halpern
- NYU Adult Congenital Heart Disease Program, Leon H. Charney Division of Cardiology, NYU Grossman School of Medicine and NYU Langone Health, New York, NY 10016, USA
| | - Christina A Penfield
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, NYU Grossman School of Medicine and NYU Langone Health, New York, NY 10016, USA
| | - Jodi L Feinberg
- NYU Adult Congenital Heart Disease Program, Leon H. Charney Division of Cardiology, NYU Grossman School of Medicine and NYU Langone Health, New York, NY 10016, USA
| | - Adam J Small
- NYU Adult Congenital Heart Disease Program, Leon H. Charney Division of Cardiology, NYU Grossman School of Medicine and NYU Langone Health, New York, NY 10016, USA
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Meng ML, Arendt KW, Banayan JM, Bradley EA, Vaught AJ, Hameed AB, Harris J, Bryner B, Mehta LS. Anesthetic Care of the Pregnant Patient With Cardiovascular Disease: A Scientific Statement From the American Heart Association. Circulation 2023; 147:e657-e673. [PMID: 36780370 DOI: 10.1161/cir.0000000000001121] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/15/2023]
Abstract
The pregnancy-related mortality rate in the United States is excessively high. The American Heart Association is dedicated to fighting heart disease and recognizes that cardiovascular disease, preexisting or acquired during pregnancy, is the leading cause of maternal mortality in the United States. Comprehensive scientific statements from cardiology and obstetrics experts guide the treatment of cardio-obstetric patients before, during, and after pregnancy. This scientific statement aims to highlight the role of specialized cardio-obstetric anesthesiology care, presenting a systematic approach to the care of these patients from the anesthesiology perspective. The anesthesiologist is a critical part of the pregnancy heart team as the perioperative physician who is trained to prevent or promptly recognize and treat patients with peripartum cardiovascular decompensation. Maternal morbidity is attenuated with expert anesthesiology peripartum care, which includes the management of neuraxial anesthesia, inotrope and vasopressor support, transthoracic echocardiography, optimization of delivery location, and consideration of advanced critical care and mechanical support when needed. Standardizing the anesthesiology approach to patients with high peripartum cardiovascular risk and ensuring that cardio-obstetrics patients have access to the appropriate care team, facilities, and advanced cardiovascular therapies will contribute to improving peripartum morbidity and mortality.
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Kops SA, Strah DD, Andrews J, Klewer SE, Seckeler MD. Contemporary pregnancy outcomes for women with moderate and severe congenital heart disease. Obstet Med 2023; 16:17-22. [PMID: 37139503 PMCID: PMC10150298 DOI: 10.1177/1753495x211064458] [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: 09/30/2021] [Accepted: 11/16/2021] [Indexed: 11/15/2022] Open
Abstract
Background Women with congenital heart disease (CHD) are surviving into adulthood, with more undergoing pregnancy. Methods Retrospective review of the Vizient database from 2017-2019 for women 15-44 years old with moderate, severe or no CHD and vaginal delivery or caesarean section. Demographics, hospital outcomes and costs were compared. Results There were 2,469,117 admissions: 2,467,589 with no CHD, 1277 with moderate and 251 with severe CHD. Both CHD groups were younger than no CHD, there were fewer white race/ethnicity in the no CHD group and more women with Medicare in both CHD groups compared to no CHD. With increasing CHD severity there was an increase in length of stay, ICU admission rates and costs. There were also higher rates of complications, mortality and caesarean section in the CHD groups. Conclusion Pregnant women with CHD have more problematic pregnancies and understanding this impact is important to improve management and decrease healthcare utilization.
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Affiliation(s)
- Samantha A Kops
- Department of Pediatrics, University of Arizona, Tucson, AZ, USA
| | - Danielle D Strah
- Department of Pediatrics, University of Arizona, Tucson, AZ, USA
| | - Jennifer Andrews
- Department of Pediatrics (Cardiology), University of Arizona, Tucson, AZ, USA
| | - Scott E Klewer
- Department of Pediatrics (Cardiology), University of Arizona, Tucson, AZ, USA
| | - Michael D Seckeler
- Department of Pediatrics (Cardiology), University of Arizona, Tucson, AZ, USA
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Echocardiographic changes and impact on clinical management in pregnant women with heart disease. Cardiol Young 2023; 33:449-456. [PMID: 35726562 DOI: 10.1017/s1047951122001135] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND While guidelines recommend echocardiography for pregnant women with heart disease, there are limited data on its effect on clinical practice. In this study, we investigated pregnancy-associated echocardiographic changes and their impact on management. METHODS This was a retrospective study of pregnant women with heart disease followed at an academic medical centre from 2016 to 2020. Data on maternal intrapartum and postpartum echocardiograms were collected and the impact on management analysed. RESULTS 421 echocardiograms in 232 pregnancies were included in the study. The most common cardiac diagnosis was CHD (60.8% of pregnancies), followed by cardiomyopathy (9.9%). The frequency of baseline echocardiographic abnormalities varied by diagnosis, with abnormal right ventricular systolic pressure being the most common (15.0% of pregnancies in CHD and 23.1% of pregnancies with cardiomyopathy). 39.2% of the 189 follow-up echocardiograms had a significant change from the prior study, with the most common changes being declines in right ventricular function (4.2%) or left ventricular function (3.7%), and increases in right ventricular systolic pressure (5.3%) and aortic size (21.2%). 17.8% of echocardiograms resulted in a clinical management change, with the most common change being shorter interval follow-up. CONCLUSIONS Echocardiographic changes in pregnant women with heart disease are common, in particular increases in aortic size. Echocardiography results in changes in management in a small but significant proportion of patients. Further studies are needed to determine how other factors, including patient access and resource allocation, factor into the use of echocardiography during pregnancy.
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Bredy C, Deville F, Huguet H, Picot MC, De La Villeon G, Abassi H, Avesani M, Begue L, Burlet G, Boulot P, Fuchs F, Amedro P. Which risk score best predicts cardiovascular outcome in pregnant women with congenital heart disease? EUROPEAN HEART JOURNAL. QUALITY OF CARE & CLINICAL OUTCOMES 2023; 9:177-183. [PMID: 35472215 DOI: 10.1093/ehjqcco/qcac019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/30/2021] [Revised: 04/03/2022] [Accepted: 04/23/2022] [Indexed: 11/14/2022]
Abstract
BACKGROUND Management of pregnancy and risk stratification in women with congenital heart diseases (CHD) are challenging, especially due to physiological haemodynamic modifications that inevitably occur during pregnancy. AIMS To compare the accuracy of the existing pregnancy cardiovascular risk scores in prediction of maternal complications during pregnancy in CHD patients. METHOD AND RESULTS From 2007 to 2018, all pregnant women with a CHD who delivered birth after 20 weeks of gestation were identified. The discriminating power and the accuracy of the five existing pregnancy cardiovascular risk scores [CARPREG, CARPREG II, HARRIS, ZAHARA risk scores, and modified WHO (mWHO)] were evaluated.Out of 104 pregnancies in 65 CHD patients, 29% experienced cardiovascular complications during pregnancy or post-partum. For the five scores, the observed rate of cardiovascular events was higher than the expected risk. The values of area under the ROC curve were 0.75 (0.62-0.88) for mWHO, 0.65 (0.53-0.77) for CARPREG II, 0.60 (0.40-0.80) for HARRIS, 0.59 (0.47-0.72) for ZAHARA, and 0.58 (0.43-0.73) for CARPREG. CONCLUSION The modified WHO classification appeared to better predict cardiovascular outcome in pregnant women with CHD than the four other existing risk scores.Clinical Trial Registration: Clinicaltrials.gov: NCT04221048.
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Affiliation(s)
- Charlene Bredy
- Paediatric and Congenital Cardiology Department, M3C Regional Reference CHD Centre, University Hospital, 34295 Montpellier, France
| | - Fanny Deville
- Paediatric and Congenital Cardiology Department, M3C Regional Reference CHD Centre, University Hospital, 34295 Montpellier, France
| | - Helena Huguet
- Epidemiology and Clinical Research Department, University Hospital, 34295 Montpellier, France
| | - Marie-Christine Picot
- Epidemiology and Clinical Research Department, University Hospital, 34295 Montpellier, France
| | - Gregoire De La Villeon
- Paediatric and Congenital Cardiology Department, M3C Regional Reference CHD Centre, University Hospital, 34295 Montpellier, France
| | - Hamouda Abassi
- Paediatric and Congenital Cardiology Department, M3C Regional Reference CHD Centre, University Hospital, 34295 Montpellier, France
| | - Martina Avesani
- Paediatric and Congenital Cardiology Department, M3C National Reference Centre, Bordeaux University Hospital, Avenue de Magellan, 33 604 Bordeaux, France
| | - Laetitia Begue
- Gynaecology and Obstetrics Department, University Hospital, 34295 Montpellier, France
| | - Gilles Burlet
- Gynaecology and Obstetrics Department, University Hospital, 34295 Montpellier, France
| | - Pierre Boulot
- Gynaecology and Obstetrics Department, University Hospital, 34295 Montpellier, France
| | - Florent Fuchs
- Gynaecology and Obstetrics Department, University Hospital, 34295 Montpellier, France
| | - Pascal Amedro
- Paediatric and Congenital Cardiology Department, M3C National Reference Centre, Bordeaux University Hospital, Avenue de Magellan, 33 604 Bordeaux, France.,IHU Liryc, Electrophysiology and Heart Modelling Institute, INSERM 1045, Bordeaux University Foundation, Av. du Haut Lévêque, 33600 Pessac, France
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Chin KM, Santiago-Munoz P. Pregnancy and Congenital Heart Disease-Associated Pulmonary Hypertension: Are Outcomes Improving? Circulation 2023; 147:562-564. [PMID: 36780392 DOI: 10.1161/circulationaha.122.063191] [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] [Indexed: 02/15/2023]
Affiliation(s)
- Kelly M Chin
- Department of Internal Medicine, Pulmonary and Critical Care Medicine (K.M.C.), University of Texas Southwestern Medical Center, Dallas
| | - Patricia Santiago-Munoz
- Department of Obstetrics and Gynecology, Maternal Fetal Medicine (P.S.-M.), University of Texas Southwestern Medical Center, Dallas
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46
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Roos-Hesselink JW, van der Zande JA, Johnson MR. Pregnancy outcomes in women with heart disease: how to improve? Eur Heart J 2023; 44:1541-1543. [PMID: 36748201 DOI: 10.1093/eurheartj/ehad035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Affiliation(s)
- Jolien W Roos-Hesselink
- Department of Cardiology, Erasmus MC, University Medical Center Rotterdam, Rg-435-PO Box 2040, 3000 CA, Rotterdam, The Netherlands
| | - Johanna A van der Zande
- Department of Cardiology, Erasmus MC, University Medical Center Rotterdam, Rg-435-PO Box 2040, 3000 CA, Rotterdam, The Netherlands.,Department of Obstetrics and Gynecology, Erasmus MC-Sophia Children's Hospital, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Mark R Johnson
- Department of Obstetric Medicine, Imperial College London, Kensington, London, UK
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47
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Farr SL, Downing KF, Tepper NK, Oster ME, Glidewell MJ, Reefhuis J. Reproductive Health of Women with Congenital Heart Defects. J Womens Health (Larchmt) 2023; 32:132-137. [PMID: 36757282 PMCID: PMC10680443 DOI: 10.1089/jwh.2022.0513] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/10/2023] Open
Abstract
This report provides an overview of the unique reproductive health issues facing women with congenital heart defects (CHDs) and of the clinical care and professional guidelines on contraception, preconception care, and pregnancy for this population. It describes Centers for Disease Control and Prevention (CDC) activities related to surveillance of reproductive health issues among females with CHDs. It also describes CDC's work bringing awareness to physicians who provide care to adolescents and women with CHDs, including obstetrician/gynecologists, about the need for lifelong cardiology care for their patients with CHDs.
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Affiliation(s)
- Sherry L Farr
- Division of Birth Defects and Infant Disorders, National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Karrie F Downing
- Division of Birth Defects and Infant Disorders, National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Naomi K Tepper
- Division of Birth Defects and Infant Disorders, National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Matthew E Oster
- Division of Birth Defects and Infant Disorders, National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Melissa J Glidewell
- Division of Birth Defects and Infant Disorders, National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Jennita Reefhuis
- Division of Birth Defects and Infant Disorders, National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
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Dall'Asta A, Minopoli M, Ramirez Zegarra R, Di Pasquo E, Ghi T. An update on maternal cardiac hemodynamics in fetal growth restriction and pre-eclampsia. JOURNAL OF CLINICAL ULTRASOUND : JCU 2023; 51:265-272. [PMID: 36377677 DOI: 10.1002/jcu.23392] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/03/2022] [Revised: 10/03/2022] [Accepted: 10/28/2022] [Indexed: 06/16/2023]
Abstract
Pre-eclampsia and fetal growth restriction (FGR) have been long related to primary placental dysfunction, caused by abnormal trophoblast invasion. Nevertheless, emerging evidence has led to a new hypothesis for the origin of pre-eclampsia and FGR. Suboptimal maternal cardiovascular adaptation has been shown to result in uteroplacental hypoperfusion, ultimately leading to placental hypoxic damage with secondary dysfunction. In this review, we summarize current evidence on maternal cardiac hemodynamics in FGR and pre-eclampsia. We also discuss the different approaches for antihypertensive treatment according to the hemodynamic phenotype observed in pre-eclampsia and FGR.
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Affiliation(s)
- Andrea Dall'Asta
- Department of Medicine and Surgery, Obstetrics and Gynecology Unit, University of Parma, Parma, Italy
| | - Monica Minopoli
- Department of Medicine and Surgery, Obstetrics and Gynecology Unit, University of Parma, Parma, Italy
| | - Ruben Ramirez Zegarra
- Department of Medicine and Surgery, Obstetrics and Gynecology Unit, University of Parma, Parma, Italy
| | - Elvira Di Pasquo
- Department of Medicine and Surgery, Obstetrics and Gynecology Unit, University of Parma, Parma, Italy
| | - Tullio Ghi
- Department of Medicine and Surgery, Obstetrics and Gynecology Unit, University of Parma, Parma, Italy
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Alliance for Innovation on Maternal Health: Consensus Bundle on Cardiac Conditions in Obstetric Care. Obstet Gynecol 2023; 141:253-263. [PMID: 36649333 PMCID: PMC9838734 DOI: 10.1097/aog.0000000000005048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2022] [Accepted: 10/21/2022] [Indexed: 01/18/2023]
Abstract
Cardiac conditions are the leading cause of pregnancy-related deaths and disproportionately affect non-Hispanic Black people. Multidisciplinary maternal mortality review committees have found that most people who died from cardiac conditions during pregnancy or postpartum were not diagnosed with a cardiovascular disease before death and that more than 80% of all pregnancy-related deaths, regardless of cause, were preventable. In addition, other obstetric complications, such as preeclampsia and gestational diabetes, are associated with future cardiovascular disease risk. Those with cardiac risk factors and those with congenital and acquired heart disease require specialized care during pregnancy and postpartum to minimize risk of preventable morbidity and mortality. This bundle provides guidance for health care teams to develop coordinated, multidisciplinary care for pregnant and postpartum people with cardiac conditions and to respond to cardio-obstetric emergencies. This bundle is one of several core patient safety bundles developed by the Alliance for Innovation on Maternal Health that provide condition- or event-specific clinical practices for implementation in appropriate care settings. The Cardiac Conditions in Obstetric Care bundle is organized into five domains: 1) Readiness , 2) Recognition and Prevention , 3) Response , 4) Reporting and Systems Learning , and 5) Respectful Care . This bundle is the first by the Alliance to be developed with the fifth domain of Respectful Care . The Respectful Care domain provides essential best practices to support respectful, equitable, and supportive care to all patients. Further health equity considerations are integrated into elements in each domain.
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Edwards P, Anyaogu C, Mezue K, Baugh D, Goha A, Egbuche O, Nunura F, Madu E. Focused cardiac ultrasound in pregnancy. J Investig Med 2023; 71:81-91. [PMID: 36691704 DOI: 10.1177/10815589221142195] [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: 01/25/2023]
Abstract
Cardiac disease in pregnancy is an important cause of maternal morbidity and mortality. In many high-income countries, acquired cardiac disease is now the largest cause of maternal mortality. Given its prevalence in low- and middle-income countries (LMICs), rheumatic heart disease is the most common cause of cardiac disease in pregnancy worldwide and is associated with poor maternal outcome. The diagnosis of cardiac disease in pregnancy is often delayed resulting in excess maternal morbidity and mortality. Maternal mortality review committees have suggested that prompt recognition and treatment of heart disease in pregnancy may improve maternal outcome. Given the similarities between symptoms of normal pregnancy and those of cardiac disease, the clinical diagnosis of heart disease in pregnancy is challenging with echocardiography being the primary diagnostic modality. Focused cardiac ultrasound (FOCUS) at the point of care provides supplemental data to the history and physical examination and has been demonstrated to permit early diagnosis and improvement in the management of cardiac disease in emergency medicine, intensive care, and anesthesia. It has also been demonstrated to be useful in surveillance for rheumatic heart disease in LMICs. The use of FOCUS may allow earlier and more accurate diagnosis of cardiac disease in pregnancy with the potential to decrease morbidity and mortality in both developed and developing countries.
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Affiliation(s)
- Paul Edwards
- Heart Institute of the Caribbean, Kingston, Jamaica
| | | | - Kenechukwu Mezue
- Cardiology Division, Department of Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - Dainia Baugh
- Heart Institute of the Caribbean, Kingston, Jamaica
| | - Ahmed Goha
- Cardiology department, Cardiac Center Hail, Hail, Saudi Arabia
| | - Obiora Egbuche
- Division of Cardiovascular Medicine, Department of Internal Medicine, Wexner Medical Center, Ohio State University, Columbus, OH, USA
| | - Felix Nunura
- Heart Institute of the Caribbean, Kingston, Jamaica
| | - Ernest Madu
- Heart Institute of the Caribbean, Kingston, Jamaica
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