scholarly journals Cardiac disease and pregnancy: hyper vigilance and extreme caution for optimal outcome

2020 ◽  
Vol 9 (2) ◽  
pp. 825
Author(s):  
Naresh Dhawan ◽  
Rohin Kumar ◽  
Reema Kumar Bhatt
Keyword(s):  
Aortic Valve ◽  
Bicuspid Aortic Valve ◽  
Cardiac Disease ◽  
Congenital Heart ◽  
Single Ventricle ◽  
Heart Diseases ◽  
Fetal Outcome ◽  
Coordinated Care ◽  
Extreme Caution ◽  
Congenital Cardiac Malformation

Cardiac disease in pregnancy is a leading cause of maternal death in more so high-income countries. The armamentarium for winning this difficult battle involves shared decision-making with communication across the clinical team and the patient. There is limited clinical evidence concerning effective approaches to managing such complex care and moreover involvement of different specialists makes coordinated care challenging. Bicuspid aortic valve (BAV) is the most common congenital cardiac malformation, occurring in 1-2% of the population whereas a single ventricle is a rare congenital heart disease that accounts for less than 1% of all congenital heart diseases. We had two cases of pregnancy with bicuspid aortic valve in one case and the other with single ventricle. The involvement of multidisciplinary team involving cardiologist, cardiothoracic anaesthetist and fetal maternal medicine specialist resulted in good maternal and fetal outcome in both the cases.

MATERNALAND FETAL OUTCOME IN PREGNANCY WITH HEART DISEASES

2021 ◽  
pp. 46-47
Author(s):  
Sweety Sinha
Keyword(s):  
Congenital Heart Disease ◽  
Heart Disease ◽  
Cardiac Disease ◽  
Congenital Heart ◽  
Heart Diseases ◽  
Mode Of Delivery ◽  
Fetal Outcome ◽  
College Hospital ◽  
Mortality And Morbidity ◽  
In Pregnancy

Background: Cardiac disease is an important cause of maternal mortality and morbidity both in antepartum and postpartum period. The overall incidence of heart disease in pregnancy is <1%. Objective of present study was to determine maternal outcome in pregnant women with heart diseases in terms of fetal complication, maternal complication and Mode of delivery. Methods: This study was conducted in the Department of Obstetrics and Gynaecology at PATNA MEDICAL COLLEGE,HOSPITAL,patna. 40 women with heart disease which were previously established or diagnosed during pregnancy were enrolled in the study. Results:In 40 women pregnancies was complicated by heart disease in the study. The prevalence of heart disease amongst all pregnancies found in hospital was 4.3%. The principal cause of cardiac lesion was Rheumatic heart disease (RHD) (62.5%) while congenital heart disease was seen in 12.5%. Among the women who had RHD, mitral stenosis seen in 15 (37.5%) was most common lesion and Multiple cardiac lesions 10 (25%) women. Among the women with congenital cardiac disease, mitral valve prolapse was most common constituting 5 (12.5%) cases. women delivered by caesarean section were14(35%) while 26(65%) had vaginal delivery. with spontaneous onset of labour in 20(50 %)and assisted instrumental vaginal delivered in 6 patients. There was 1 maternal death. No baby had congenital heart disease. 70% babies born weighed more than 2kg. Conclusions:This study concluded that pre- pregnancy diagnosis, counselling, appropriate referral, antenatal supervision and delivery at equipped centre improve the pregnancy with heart disease outcome for both mother and baby

P3735Incidence of bicuspid aortic valve in 16,185 neonates by echocardiographic screening in a single institution: is it really congenial?

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
K Waki ◽  
K Ueda ◽  
K Satoh ◽  
K Ogino ◽  
T Hayashi ◽  
...  
Keyword(s):  
Aortic Valve ◽  
Bicuspid Aortic Valve ◽  
Congenital Heart ◽  
Heart Diseases ◽  
Coarctation Of The Aorta ◽  
Later Life ◽  
Population Based ◽  
True Incidence ◽  
Incidence Data ◽  
The Right

Abstract Background Bicuspid aortic valve (BAV) has been reported to be the most common congenital heart disease with an incidence of 1 to 2% in the general population; however, its incidence in neonates is still unclear because most of the reported incidence data are based on surgical or autopsy cases in adults. Purpose To elucidate the true incidence of congenital isolated BAV in neonates by echocardiographic screening in a population-based study. Methods We examined a total of 16,185 full-term neonates (male, 48.9%) born in our institution during either of the following two periods: September 1986 to February 2008 and October 2014 to September 2017. Mean gestational age (range) was 39.4 (36 to 42) weeks, and mean birth weight (range) was 3075 (2268 to 4622) g. On the second day after birth, we performed echocardiography and colour-Doppler flow mapping in all subjects. BAV was classified into two types on the basis of morphologicfindings in the parasternal short axis view of the aortic valve: BAV with raphe harbouring two cusps and commissures, showing a congenital fusion of two underdeveloped cusps, and BAV without raphe, showing a fish mouth appearance in systolic images. BAV associated with other congenital heart diseases such as coarctation of the aorta was excluded from this study. Results BAV was identified in 14 neonates (0.09%), an incidence of 0.9 in 1,000 live births. Of the 14 BAV neonates, five had BAV with raphe, whereas nine had BAV without raphe. Of the five BAV neonates with raphe, four had fusion of the right and noncoronary cusps, whereas one had that of the right and left coronary cusps. No aortic regurgitation was detected except trivial one in only one neonate, and no significant valvar stenosis was detected. Conclusion The incidence of BAV in neonates was much lower than previously reported incidence data. An acquired fusion of the cusps may develop in later life, and eventually may result in increased incidence of functional BAV.

scholarly journals Urinary Metabolomics Study of Patients with Bicuspid Aortic Valve Disease

Molecules ◽  
2021 ◽  
Vol 26 (14) ◽  
pp. 4220
Author(s):  
Massimo Chessa ◽  
Mario Panebianco ◽  
Sara Corbu ◽  
Milena Lussu ◽  
Angelica Dessì ◽  
...  
Keyword(s):  
Aortic Valve ◽  
Bicuspid Aortic Valve ◽  
Metabolic Pathways ◽  
Congenital Heart ◽  
Roc Analysis ◽  
Operating Characteristic ◽  
Molecular Fingerprint ◽  
Metabolomics Study ◽  
Cardiovascular Anomalies ◽  
Potential Use

Bicuspid aortic valve (BAV) is the most common congenital heart defect responsible for valvular and aortic complications in affected patients. Causes and mechanisms of this pathology are still elusive and thus the lack of early detection biomarkers leads to challenges in its diagnosis and prevention of associated cardiovascular anomalies. The aim of this study was to explore the potential use of urine Nuclear Magnetic Resonance (NMR) metabolomics to evaluate a molecular fingerprint of BAV. Both multivariate and univariate statistical analyses were performed to compare the urinary metabolome of 20 patients with BAV with that of 24 matched controls. Orthogonal partial least squared discriminant analysis (OPLS-DA) showed statistically significant discrimination between cases and controls, suggesting seven metabolites (3-hydroxybutyrate, alanine, betaine, creatine, glycine, hippurate, and taurine) as potential biomarkers. Among these, glycine, hippurate and taurine individually displayed medium sensitivity and specificity by receiver operating characteristic (ROC) analysis. Pathway analysis indicated two metabolic pathways likely perturbed in BAV subjects. Possible contributions of gut microbiota activity and energy imbalance are also discussed. These results constitute encouraging preliminary findings in favor of the use of urine-based metabolomics for early diagnosis of BAV.

scholarly journals The bicuspid aortic valve and related disorders

2010 ◽  
Vol 128 (5) ◽  
pp. 296-301 ◽  
Author(s):  
Shi-Min Yuan ◽  
Hua Jing
Keyword(s):  
Aortic Valve ◽  
Bicuspid Aortic Valve ◽  
Thrombus Formation ◽  
Beta Blockers ◽  
Ductus Arteriosus ◽  
Treatment Strategies ◽  
Hereditary Diseases ◽  
Laboratory Findings ◽  
Male Predominance ◽  
Congenital Cardiac Malformation

Bicuspid aortic valve (BAV) is the most common congenital cardiac malformation, affecting 1-2% of the population, with strong male predominance. Individuals may have a normally functioning BAV, and may be unaware of its presence and the potential risk of complications. However, they may easily develop aortic valve disorders: either stenotic or regurgitant, or both. Today, BAV is recognized as a syndrome incorporating aortic valve disorders and aortic wall abnormalities, including aortic dilation, dissection or rupture. Congenital or hereditary diseases such as ventricular septal defect, patent ductus arteriosus, coarctation of the aorta, Turner's syndrome, Marfan's syndrome etc., may frequently be associated with BAV. Infective endocarditis and occasionally thrombus formation may develop during the lives of BAV patients. Elevated cholesterol or C-reactive protein may be seen in laboratory findings of these patients. Beta-blockers and statins are the possibilities for medical treatment, and aortic valve repair/replacement and ascending aorta replacement are indicated for patients with a severely diseased aortic valve and aorta. Rigorous follow-up throughout life is mandatory after BAV has been diagnosed. The aim of the present article was to describe the implications of BAV and its associated disorders, and to discuss diagnostic and treatment strategies.

Incidence, morphology, and progression of bicuspid aortic valve in pediatric and young adult subjects with coexisting congenital heart defects

2016 ◽  
Vol 12 (3) ◽  
pp. 261-269 ◽  
Author(s):  
Talha Niaz ◽  
Joseph T. Poterucha ◽  
Jonathan N. Johnson ◽  
Cecilia Craviari ◽  
Thomas Nienaber ◽  
...  
Keyword(s):  
Young Adult ◽  
Aortic Valve ◽  
Bicuspid Aortic Valve ◽  
Congenital Heart Defects ◽  
Congenital Heart ◽  
Heart Defects

scholarly journals Bicuspid Aortic Valve in 2 Model Species and Review of the Literature

2020 ◽  
Vol 57 (2) ◽  
pp. 321-331 ◽  
Author(s):  
Borja Fernández ◽  
María Teresa Soto-Navarrete ◽  
Alejandro López-García ◽  
Miguel Ángel López-Unzu ◽  
Ana Carmen Durán ◽  
...  
Keyword(s):  
Animal Models ◽  
Aortic Valve ◽  
Bicuspid Aortic Valve ◽  
Wide Spectrum ◽  
Genetically Modified ◽  
Type A ◽  
Mouse Strains ◽  
Genetic Modifiers ◽  
Interspecific Differences ◽  
Congenital Cardiac Malformation

Bicuspid aortic valve (BAV) is the most common human congenital cardiac malformation. Although the etiology is unknown for most patients, formation of the 2 main BAV anatomic types (A and B) has been shown to rely on distinct morphogenetic mechanisms. Animal models of BAV include 2 spontaneous hamster strains and 27 genetically modified mouse strains. To assess the value of these models for extrapolation to humans, we examined the aortic valve anatomy of 4340 hamsters and 1823 mice from 8 and 7 unmodified strains, respectively. In addition, we reviewed the literature describing BAV in nonhuman mammals. The incidences of BAV types A and B were 2.3% and 0.03% in control hamsters and 0% and 0.3% in control mice, respectively. Hamsters from the spontaneous model had BAV type A only, whereas mice from 2 of 27 genetically modified strains had BAV type A, 23 of 27 had BAV type B, and 2 of 27 had both BAV types. In both species, BAV incidence was dependent on genetic background. Unlike mice, hamsters had a wide spectrum of aortic valve morphologies. We showed interspecific differences in the occurrence of BAV between humans, hamsters, and mice that should be considered when studying aortic valve disease using animal models. Our results suggest that genetic modifiers play a significant role in both the morphology and incidence of BAV. We propose that mutations causing anomalies in specific cardiac morphogenetic processes or cell lineages may lead to BAV types A, B, or both, depending on additional genetic, environmental, and epigenetic factors.

scholarly journals Characteristics of Bicuspid Aortic Valve Disease and Stenosis: The National Echo Database of Australia

2021 ◽  
Author(s):  
Michelle S. Lim ◽  
Geoff Strange ◽  
David Playford ◽  
Simon Stewart ◽  
David S. Celermajer
Keyword(s):  
Congenital Heart Disease ◽  
Heart Disease ◽  
Aortic Valve ◽  
Bicuspid Aortic Valve ◽  
Aortic Valve Disease ◽  
Congenital Heart ◽  
Severe Aortic Stenosis ◽  
Unique Identifier ◽  
Favorable Prognosis ◽  
Age And Sex

Background Bicuspid aortic valve (BAV) is the most common congenital heart disease in adults but is clinically heterogeneous. We aimed to describe the echocardiographic characteristics of BAV and compare patients with BAV with moderate‐to‐severe aortic stenosis (AS) with those with tricuspid aortic valve (TAV) stenosis. Methods and Results Using the National Echo Database of Australia, patients in whom BAV was identified were studied. Those with moderate‐to‐severe AS (mean gradient >20 mm Hg [BAV‐AS]) were compared with those with TAV and moderate‐to‐severe AS (TAV‐AS). Of 264 159 adults whose aortic valve morphology was specified, 4783 (1.8%) had confirmed BAV (aged 49.6±17.4 years, 69% men). Of these, 42% had no AS, and 46% had no aortic regurgitation. Moderate‐to‐severe AS was detected in a greater proportion of patients with BAV with a recorded mean gradient (n=1112, 34%) compared with those with TAV (n=4377, 4%; P <0.001). Patients with BAV‐AS were younger (aged 55.3±16.7 years versus 77.3±11.0 years; P <0.001), and where measured had larger ascending aortic diameters (37±8 mm versus 35±5 mm; P <0.001). Age and sex‐adjusted mortality risk was significantly lower in patients with BAV‐AS (hazard ratio, 0.53; 95% CI, 0.45–0.63; P <0.001). Conclusions In this large study of patients across the spectrum of BAV disease, the largest proportion had no significant valvulopathy or aortopathy. Compared with those with TAV‐AS, patients with BAV were more likely to have moderate‐to‐severe AS, have larger ascending aortas, and were over 2 decades younger at the time of AS diagnosis. Despite this, patients with BAV appear to have a more favorable prognosis when AS develops, compared with those with TAV‐AS. Registration URL: www.anzctr.org.au/ ; Unique identifier: ACTRN12617001387314.

Three cusps are better than two: bicuspid aortic valve and implications for military service

2018 ◽  
Vol 166 (3) ◽  
pp. 167-170
Author(s):  
Andrew Williams ◽  
M Awadalla
Keyword(s):  
Aortic Valve ◽  
Bicuspid Aortic Valve ◽  
Military Service ◽  
Heart Association ◽  
Time Frame ◽  
Valve Disease ◽  
Aortic Dilatation ◽  
Military Career ◽  
Congenital Cardiac Malformation ◽  
Better Than

Bicuspid aortic valve (BAV) is the most common congenital cardiac malformation. It is an aortopathy and is associated with other congenital heart disease. Although there is no mortality increase with BAV, the natural history increases the risk of aortic valve disease, aortic dilatation and infective endocarditis over the time frame of a full military career. Military service theoretically increases the risk of aortic dilatation and endocarditis in BAV. Conversely, there are some who have BAV who would not suffer any complications during their military career. Currently, potential UK Army recruits undergo personal/family history and physical examination plus an ECG and, although this goes beyond American Heart Association guidelines, it does not screen specifically for BAV. This would necessitate a transthoracic echo for each potential recruit but would be a considerable increase in resources–both time and financial. In addition to the recruitment medical, military personnel undergo frequent medicals, which could identify those who develop significant valvular disease. Those with mild valve disease are at lowest risk of complication. Those with aortic dilatation only remain a concern.

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