Management during pregnancy

ESC CardioMed ◽  
2018 ◽  
pp. 1702-1704
Author(s):  
Johan Holm ◽  
Bernard Iung
Keyword(s):  
Systolic Function ◽  
Left Ventricular Systolic Function ◽  
Left Ventricular ◽  
Valvular Disease ◽  
Cardiac Complications ◽  
Thromboembolic Complications ◽  
Mechanical Prosthesis ◽  
Haemodynamic Changes ◽  
Maternal Risks ◽  
Mitral Commissurotomy

Physiologic haemodynamic changes during pregnancy carry a risk of cardiac complications in women with valvular disease. Mitral stenosis with valve area <1.5 cm² is poorly tolerated and percutaneous mitral commissurotomy is needed during pregnancy if symptoms persist under medical therapy. The risk of complications is lower with aortic stenosis when women were asymptomatic before pregnancy with preserved left ventricular function. Chronic regurgitations are generally well tolerated, even when severe, provided left ventricular systolic function is preserved. Surgery under cardiopulmonary bypass should be avoided during pregnancy due to the fetal risk. There is a high risk of thromboembolic complications during pregnancy in women with a mechanical prosthesis, leading to maternal mortality between 1-4%. The choice of the modalities of anticoagulant therapy should weigh fetal and maternal risks after careful patient information. Given its complexity and risks, the management of pregnant patients with valvular disease should be performed in multidisciplinary cardiac-obstetric team.

Management during non-cardiac surgery

ESC CardioMed ◽  
2018 ◽  
pp. 1700-1702
Author(s):  
Johan Holm ◽  
Bernard Iung
Keyword(s):  
Cardiac Surgery ◽  
Aortic Stenosis ◽  
Systolic Function ◽  
Severe Aortic Stenosis ◽  
Left Ventricular Systolic Function ◽  
Cardiovascular Complications ◽  
Left Ventricular ◽  
Mechanical Prosthesis ◽  
Asymptomatic Patients ◽  
Mitral Commissurotomy

The risk of cardiovascular complications in patients undergoing non-cardiac surgery depends risk on the type of non-cardiac surgery, classified into 3 groups, and the type and severity of valvular disease. The risk of complications is highest in aortic stenosis In symptomatic patients, aortic stenosis should be treated before non-cardiac surgery, while asymptomatic patients with severe aortic stenosis can undergo elective non-cardiac surgery. In symptomatic patients with mitral stenosis, percutaneous mitral commissurotomy should be attempted before high-risk non-cardiac surgery. In asymptomatic patients with severe regurgitation and preserved left ventricular systolic function, non-cardiac surgery can be performed safely. In patients with mechanical prosthesis, the main problem is the adaptation of the modalites of anticoagulant therapy.

Specific diseases: valvular heart disease

ESC CardioMed ◽  
2018 ◽  
pp. 2666-2667
Author(s):  
Bernard Iung ◽  
Luc A. Pierard
Keyword(s):  
Cardiac Surgery ◽  
Aortic Stenosis ◽  
Perioperative Complications ◽  
Left Ventricular ◽  
Valvular Disease ◽  
Left Ventricular Ejection ◽  
Mechanical Prosthesis ◽  
Ventricular Ejection Fraction ◽  
Asymptomatic Patients ◽  
Mitral Commissurotomy

The evaluation of the risk of non-cardiac surgery in patients with valvular disease should take into account the type, severity, and tolerance of valvular disease, and the risk inherent to non-cardiac surgery. Aortic stenosis carries the highest risk of perioperative complications. Except for emergency non-cardiac surgery, an intervention on the aortic valve is indicated firstly in case of severe symptomatic aortic stenosis. In asymptomatic patients, low- and intermediate-risk non-cardiac surgery can be performed, while the strategy should be individualized for high-risk non-cardiac surgery. Balloon aortic valvuloplasty may be used as a bridge if non-cardiac surgery is urgent. Percutaneous mitral commissurotomy should be considered in symptomatic patients with severe mitral stenosis. In patients with severe aortic or mitral regurgitation, the risk of non-cardiac surgery is low if they are asymptomatic with preserved left ventricular ejection fraction. In patients with a mechanical prosthesis, perioperative anticoagulant therapy should be adapted to the haemorrhagic risk of intervention and to the patient- and prosthesis-related thromboembolic risk.

scholarly journals Management of COVID-19 myopericarditis with reversal of cardiac dysfunction after blunting of cytokine storm: a case report

2020 ◽  
Vol 4 (FI1) ◽  
pp. 1-6 ◽  
Author(s):  
Angela Li ◽  
Youssef Garcia-Bengochea ◽  
Richard Stechel ◽  
Bani M Azari
Keyword(s):  
Systolic Function ◽  
Left Ventricular Systolic Function ◽  
Left Ventricular ◽  
Cardiac Complications ◽  
Severe Left Ventricular Dysfunction ◽  
St Segment Elevation ◽  
St Segment ◽  
Viral Illness ◽  
Electrocardiogram Ecg ◽  
Worse Prognosis

Abstract Background Coronavirus disease 2019 (COVID-19) is a syndrome that has been associated with multiple cardiac complications including myopericarditis. The pathophysiology and treatment for myopericarditis in the setting of COVID-19 infection is still under investigation. Case summary We present a case of a 60-year-old male admitted for dyspnoea due to COVID-19. He developed new ST-segment elevation, elevated cardiac enzymes, severe left ventricular dysfunction, and high inflammatory markers in the setting of haemodynamic and respiratory collapse from the viral illness. He was diagnosed with COVID-19-induced myopericarditis. He showed rapid clinical improvement with a rapid wean off pressure support, resolution of electrocardiogram (ECG) findings, and recovery of left ventricular systolic function following treatment with intravenous immunoglobulin (IVIG) and methylprednisolone. Discussion COVID-19’s complex and devastating complications continue to create new challenges for clinicians. Cardiac complications, specifically, have been shown to be a signal for worse prognosis in these patients. IVIG and steroids can inhibit the inflammatory cascade and decrease myocardial injury, with implications in treatment of severe myopericarditis.

scholarly journals Papillary Muscle Repositioning as a Subvalvular Apparatus Preservation Technique in Mitral Stenosis Patients with Normal Left Ventricular Systolic Function

2014 ◽  
Vol 41 (1) ◽  
pp. 33-39 ◽  
Author(s):  
Gokhan Lafci ◽  
Kerim Cagli ◽  
Omer Faruk Cicek ◽  
Kemal Korkmaz ◽  
Osman Turak ◽  
...  
Keyword(s):  
Papillary Muscle ◽  
Mitral Stenosis ◽  
Systolic Function ◽  
Left Ventricular Systolic Function ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Ventricular Systolic Function ◽  
Related Factors ◽  
Mechanical Prosthesis

Subvalvular apparatus preservation is an important concept in mitral valve replacement (MVR) surgery that is performed to remedy mitral regurgitation. In this study, we sought to determine the effects of papillary muscle repositioning (PMR) on clinical outcomes and echocardiographic left ventricular function in rheumatic mitral stenosis patients who had normal left ventricular systolic function. We prospectively assigned 115 patients who were scheduled for MVR surgery with mechanical prosthesis to either PMR or MVR-only groups. Functional class and echocardiographic variables were evaluated at baseline and at early and late postoperative follow-up examinations. All values were compared between the 2 groups. The PMR group consisted of 48 patients and the MVR-only group of 67 patients. The 2 groups’ baseline characteristics and surgery-related factors (including perioperative mortality) were similar. During the 18-month follow-up, all echocardiographic variables showed a consistent improvement in the PMR group; the mean left ventricular ejection fraction deteriorated significantly in the MVR-only group. Comparison during follow-up of the magnitude of longitudinal changes revealed that decreases in left ventricular end-diastolic and end-systolic diameters and in left ventricular sphericity indices, and increases in left ventricular ejection fractions, were significantly higher in the PMR group than in the MVR-only group. This study suggests that, in patients with rheumatic mitral stenosis and preserved left ventricular systolic function, the addition of papillary muscle repositioning to valve replacement with a mechanical prosthesis improves left ventricular dimensions, ejection fraction, and sphericity index at the 18-month follow-up with no substantial undesirable effect on the surgery-related factors.

scholarly journals CARDIAC COMPLICATIONS IN DUCHENNE MUSCULAR DYSTROPHY IN CHILDREN

2015 ◽  
Vol 64 (4) ◽  
pp. 378-382
Author(s):  
Ioana Grigore ◽  
◽  
Mariana Frasin ◽  
Georgeta Diaconu ◽  
◽  
...  
Keyword(s):  
Duchenne Muscular Dystrophy ◽  
Muscular Dystrophy ◽  
Systolic Function ◽  
Clinical Manifestations ◽  
Left Ventricular Systolic Function ◽  
Left Ventricular ◽  
Cardiac Complications ◽  
Echocardiographic Examination ◽  
Neurological Exam ◽  
Tissue Changes

Cardiac complications are frequently diagnosed in Duchenne muscular dystrophy (DMD), clinical manifestations generally appear after age 10. ECG recordings objectified various changes in these patients, the most common being represented by extensive R waves in V1, left deep Q waves, conduction abnormalities and arrhythmias. Echocardiographic examination may objective the presence of subclinical cardiac dysfunction in children under 12 years old diagnosed with DMD. In patients where standard echocardiographic examination is normal, myocardial performance index is a parameter useful in early detection of asymptomatic cardiac abnormalities. Cardiovascular magnetic resonance provides information both on left ventricular systolic function and myocardial tissue changes and occurrence of fibrosis, lesions rarely objectified before the age of 10 years. All these explorations should be considered in children with DMD at the end of a complete neurological exam.

scholarly journals Case report: high-grade atrioventricular block in suspected COVID-19 myocarditis

2020 ◽  
Vol 4 (FI1) ◽  
pp. 1-6 ◽  
Author(s):  
Vishnu Ashok ◽  
Wei Ian Loke
Keyword(s):  
Atrioventricular Block ◽  
Troponin I ◽  
Systolic Function ◽  
Pacemaker Implantation ◽  
Conduction Block ◽  
Left Ventricular Systolic Function ◽  
Left Ventricular ◽  
Cardiac Complications ◽  
Block Type ◽  
High Grade

Abstract Background In the ongoing pandemic of COVID-19, respiratory failure has been reported as the main cause of death in those who develop critical illness. A few cases of concurrent myocarditis have been reported, but the extent of cardiac complications with the SARS-CoV-2 strain of coronavirus is still largely unknown. Case summary A 53-year-old man, suspected to have COVID-19 due to a new-onset cough, shortness of breath, and hypoxia, was referred to Cardiology with sudden symptomatic bradycardia. Initial rhythm analysis revealed Type 2 atrioventricular block (Mobitz II). On arrival at the coronary care unit, he was found to be in complete heart block (Type 3). Routine blood tests showed normal electrolytes and renal function, and no elevation in troponin-I levels. Echocardiography showed mild impairment in left ventricular systolic function, with no regional wall motion abnormalities or valvular lesions. He then developed high-degree AV block lasting 6.2 s, prompting the need for an urgent permanent pacemaker implantation. Discussion Just over a third of patients with myocarditis reportedly develop a rise in cardiac troponin. Clinically suspected myocarditis can occur in the absence of a troponin rise and rarely can cause high-grade bradyarrhythmias. Myocarditis and non-specific cardiac arrhythmias have been reported in a few cases of COVID-19, but this is the first reported case of a high-grade atrioventricular conduction block with SARS-CoV-2 infection.

Sign in / Sign up

Export Citation Format

Share Document