scholarly journals Prosthetic Heart Valves and Pregnancy: Challenges and Solutions

2018 ◽  
Vol 03 (02/03) ◽  
pp. 115-125
Author(s):  
Akshyaya Pradhan ◽  
Vikas Gupta ◽  
Pravesh Vishwakarma
Keyword(s):  
Heart Valves ◽  
Heart Diseases ◽  
Care Center ◽  
Tertiary Care ◽  
Normal Pregnancy ◽  
High Rate ◽  
Prosthetic Heart Valves ◽  
Prosthetic Valves ◽  
Dose Warfarin ◽  
Valvular Heart Diseases

AbstractWith improved outcomes of valvular heart diseases and prosthetic valves, many women now survive into child-bearing age and pregnancy. However, the presence of prosthetic valves in pregnancy has an adverse impact on both maternal and fetal outcomes. The bioprosthetic or tissue valves are less thrombogenic. They do not need any anticoagulation and lead to normal pregnancy with normal baseline valve function. However, they have high rate of structural degeneration, especially in the young with an attendant need of reoperation leading to morbidity. Mechanical valves have excellent hemodynamics during pregnancy but are inherently thrombogenic leading to thromboembolic complications, necessitating uninterrupted anticoagulation. Anticoagulation itself leads to a host of maternal and fetal bleeding complication as well as adverse fetal anomalies. The use of low-dose warfarin throughout pregnancy has the best maternal safety profile. Added to this regimen, targeted replacement with parenteral heparin during the first (6–12 weeks) and late third trimesters (beyond 36 weeks) leads to virtual elimination of embryopathy as well as appreciable reductions of maternal mortality. Proper preconception counseling and antenatal care coupled with planned labor or delivery is essential to ensure best outcomes. These patients are best managed in a tertiary care center with proper expertise in managing adverse cardiovascular, obstetric, and neonatal outcomes.

Tricuspid and pulmonary valve disease

2021 ◽  
pp. 211-221
Author(s):  
Denisa Muraru ◽  
Elif Leyla Sade
Keyword(s):  
Heart Valves ◽  
Pulmonary Valve ◽  
Multimodality Imaging ◽  
Heart Diseases ◽  
Imaging Modality ◽  
Valvular Heart Diseases ◽  
Alternative Modality ◽  
The Right ◽  
Transcatheter Interventions ◽  
Valve Diseases

Right heart valves have gained significant interest in the context of a plethora of new emerging percutaneous transcatheter interventions for treating tricuspid and pulmonary valve diseases. Multimodality imaging is pivotal for patient diagnosis, management, and prognosis, as well as for planning interventional and surgical valve procedures. Echocardiography is the primary imaging modality for initial diagnosis and longitudinal follow-up of patients with right-sided valvular heart disease. Cardiovascular magnetic resonance has emerged as a complementary or alternative modality for providing diagnostic information on the tricuspid and pulmonary valve anatomy, and particularly on the pulmonary artery and the consequences on the right ventricle. This chapter highlights the current use of various imaging modalities for the state-of-the-art assessment of right-sided valvular heart diseases, with emphasis on the main clinical indications, as well as on the strengths and limitations of each modality.

Abnormal pathology seen on appendectomy in patients with predominant right-sided pelvic pain

2020 ◽  
Vol 12 (3-4) ◽  
pp. 142-150
Author(s):  
Catherine W Cai ◽  
Katelin E Sisler ◽  
Jeffrey A Gavard ◽  
Jose D Eugenio-Colon ◽  
Patrick P Yeung
Keyword(s):  
Pelvic Pain ◽  
Care Center ◽  
Tertiary Care ◽  
High Rate ◽  
Retrospective Case ◽  
Saint Louis ◽  
Pain Location ◽  
Significant Difference ◽  
Incidental Appendectomy ◽  
Abnormal Pathology

Introduction: Previous studies have linked chronic pelvic pain (CPP) to appendix pathologies. However, few studies have investigated appendix pathology specifically in the context of CPP that is right-side predominant (R-CPP). We hypothesized that women with R-CPP have higher rates of appendix pathology compared with women with CPP that is not right-side predominant (N-CPP). Methods: We conducted a retrospective case–control study of 220 women who underwent diagnostic laparoscopy and planned or incidental appendectomy for CPP and suspected endometriosis between January 2015 and December 2018 at a tertiary care center in Saint Louis, MO. Results: No significant difference in abnormal appendix pathology was found between women with R-CPP and women with N-CPP (30.9% vs 34.5%, p = 0.74, odds ratio = 0.85, 95% CI: (0.44, 1.62)). Gross abnormalities of the appendix were documented in 40 of 220 patients (18.2%), with the most common abnormal gross findings being adhesions (8.2%), followed by abnormal lesions (7.3%). Conclusion: In this study, the presence of abnormal pathology within the appendix did not correlate with R-CPP, indicating triage based on predominant pain location cannot help identify patients with underlying appendix pathology. However, consistent with previous studies, we identified a high rate of abnormal appendix pathology overall, supporting the practice of many surgeons to perform routine appendectomy in women with CPP.

scholarly journals Imaging of Cardiac Valves by Computed Tomography

Scientifica ◽  
2013 ◽  
Vol 2013 ◽  
pp. 1-13 ◽  
Author(s):  
Gudrun Feuchtner
Keyword(s):  
Computed Tomography ◽  
Heart Valves ◽  
Severe Aortic Stenosis ◽  
Multislice Ct ◽  
Valvular Disease ◽  
Special Focus ◽  
Prosthetic Heart Valves ◽  
Cardiac Valves ◽  
Effective Treatment Option ◽  
Prosthetic Valves

This paper describes “how to” examine cardiac valves with computed tomography, the normal, diseased valves, and prosthetic valves. A review of current scientific literature is provided. Firstly, technical basics, “how to” perform and optimize a multislice CT scan and “how to” interpret valves on CT images are outlined. Then, diagnostic imaging of the entire spectrum of specific valvular disease by CT, including prosthetic heart valves, is highlighted. The last part gives a guide “how to” use CT for planning of transcatheter aortic valve implantation (TAVI), an emerging effective treatment option for patients with severe aortic stenosis. A special focus is placed on clinical applications of cardiac CT in the context of valvular disease.

scholarly journals 203. Correlating Cardiac PET Results with Intra-Operative Findings in Infectious Endocarditis

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S120-S120
Author(s):  
Sami El-Dalati ◽  
Richard Weinberg ◽  
Venkatesh Murthy ◽  
Anna Owczarczyk ◽  
Jamie Riddell ◽  
...  
Keyword(s):  
Care Center ◽  
Tertiary Care ◽  
Infectious Endocarditis ◽  
Cardiac Pet ◽  
Cardiac Positron Emission Tomography ◽  
Prosthetic Valves ◽  
Duke Criteria ◽  
Positron Emission ◽  
Low Sensitivity ◽  
Operative Findings

Abstract Background Care for patients with infectious endocarditis is complicated by delays in diagnosis and relatively low sensitivity of existing diagnostic algorithms, particularly the Duke Criteria. In recent years, cardiac positron emission tomography (PET) has been identified as a useful tool in detecting occult endocardial infections. Multiple prospective studies have demonstrated that when incorporated with conventional imaging modalities cardiac PET can improve the sensitivity of the Duke Criteria by 27–38 percent. These studies used as their gold standard for diagnosis the consensus opinion of an endocarditis team and were characterized by a relatively low percentage of patients who underwent surgery. We reviewed 4 years of surgically managed IE cases at a tertiary care center where cardiac PET was used to aid diagnosis. Methods Between July 1, 2014 and December 31, 2018 we retrospectively reviewed 68 surgically managed cases of endocarditis. Cases were identified using ICD-9 and ICD-10 codes of patients who underwent surgical valve replacement for endocarditis as well as all patients who had cardiac PET scans to rule out endocarditis. Variables including PET results, operative findings, valve culture, pathology and PCR testing were recorded. Results 14 patients were identified who underwent cardiac PET prior to their surgical intervention. 9 cases were classified as possible endocarditis by Duke Criteria and 10 involved prosthetic valves. 12/14 scans were interpreted as suggestive of or consistent with endocarditis. Twelve positive PETs were associated with either operative findings of infection and/or positive PCR testing on the excised valve (positive predictive value: 100%). The 2 patients with negative scans were found to have noninfectious vegetations intra-operatively, negative valve cultures and negative pathology. Conclusion Cardiac PET correlates closely with intra-operative findings in patients with endocarditis. In patients with suspected endocarditis it may help guide surgical decision making. Cardiac PET should be considered for addition to the Modified Duke’s Criteria similar to the European Society of Cardiology guidelines. Disclosures All authors: No reported disclosures.

scholarly journals Platelet Suppression Therapy in Arterial Disease: Present Status

1977 ◽  
Author(s):  
J. A. Blakely
Keyword(s):  
Secondary Prevention ◽  
Heart Valves ◽  
Case Reports ◽  
Myocardial Infarct ◽  
Arterial Disease ◽  
Preliminary Evidence ◽  
Prosthetic Heart Valves ◽  
Prosthetic Valves ◽  
Survival Studies ◽  
Cerebral Ischemic

Arterial disease is a severe test of clinical trials methodology. Results to date have defined areas for further study, but clinical indications are not established. Dipyridamole reduces emboli from prosthetic heart valves but applicability to less thrombogenic valves is uncertain. Transient cerebral ischemic attacks are physiologically appropriate and there is preliminary evidence of reduced attacks with Sulfinpyrazone, none with Dipyridamole, and favorable case reports with Aspirin. Effects on stroke and death in patients presenting with TIA or stroke are under study. Sulfinpyrazone has failed to prolong patency time after peripheral vascular surgery. Administration of aspirin and of Sulfinpyrazone to elderly populations has shown no detectable benefit from Aspirin, and has suggested that Sulfinpyrazone should be further studied in patients recovered from thrombotic stroke. The greatest potential benefit may be secondary prevention of myocardial infarct, but to date efficacy has neither been demonstrated nor excluded. Studies in progress include: ASA and/or Sulfinpyrazone and TIA, stroke and death in patients with TIA; ASA with and without Dipyridamole in patients with TIA: Sulfinpyrazone and survival after recovery from thrombotic stroke; Secondary prevention of myocardial infarct with ASA, ASA or ASA + Dipyridamole, Sulfinpyrazone, and Clofibrate; Sulfinpyrazone, ASA, and ASA with anticoagulants and emboli from prosthetic valves. Platelet survival studies may permit selection of populations likely to benefit and assessment of adequacy of therapy.Hypotheses tested by clinical trial must be distinguished from hypotheses formulated from retrospective analysis, and methods must permit effects of treatment to be distinguished from differences in risk.

scholarly journals The Burden of Laboratory-confirmed Influenza Infection in Lebanon Between 2008 and 2016: A single tertiary care center experience

2020 ◽  
Author(s):  
Aia Assaf-Casals ◽  
Zeina Saleh ◽  
Sarah Khafaja ◽  
Danielle Fayad ◽  
Hady Ezzeddine ◽  
...  
Keyword(s):  
Influenza A ◽  
Influenza Infection ◽  
Care Center ◽  
Severe Disease ◽  
Tertiary Care ◽  
High Rate ◽  
World Health ◽  
Influenza B ◽  
Age Group ◽  
Tertiary Care Center

Abstract BACKGROUND: Influenza is a major cause of morbidity and mortality worldwide. Following the 2009 pandemic, there was widened interest in studying influenza burden in all regions. However, since data from the World Health Organization (WHO) Middle East and North Africa (MENA) region remain limited, we aimed to contribute to the understanding of influenza burden in Lebanon. METHODS: A retrospective chart review extending over a period of 8 seasons from Jan 1st, 2008 till June 30 th , 2016 at a tertiary care center in Beirut was performed. All cases confirmed to have influenza based on rapid antigen detection or/and polymerase chain reaction on a respiratory sample were included for analysis. Data on epidemiology, clinical presentation, complications, antiviral use and mortality were collected for analysis. RESULTS: A total of 1829 cases of laboratory-confirmed influenza were identified. Average annual positivity rate was 14% (positive tests over total requested). Both influenza A and B co-circulated in each season with predominance of influenza A. Influenza virus started circulating in December and peaked in January and February. The age group of 19-50 years accounted for the largest proportion of cases (22.5%) followed by the age group of 5-19 years (18%). Pneumonia was the most common complication reported in 33% of cases. Mortality reached 3.8%. The two extremes of age (<2 years and ≥ 65years) were associated with a more severe course of disease, hospitalization, intensive care unit (ICU) admission, complications, and mortality rate. Of all the identified cases, 26% were hospitalized. Moderate-to-severe disease was more likely in influenza B cases but no difference in mortality was reported between the two types. Antivirals were prescribed in 68.8% and antibiotics in 41% of cases. There seemed to be an increasing trend in the number of diagnosed and hospitalized cases over the years of the study. CONCLUSION: Patients with laboratory-confirmed influenza at our center had a high rate of hospitalization and mortality. A population based prospective surveillance study is needed to better estimate the burden of Influenza in Lebanon that would help formulate a policy on influenza control.

Sign in / Sign up

Export Citation Format

Share Document