scholarly journals To Study the Maternal and Neonatal Outcomes of Pregnancies complicated by Rheumatic Heart Disease

2014 ◽  
Vol 5 (3) ◽  
pp. 92-94
Author(s):  
Uma Pandey
Keyword(s):  
Heart Disease ◽  
Rheumatic Heart Disease ◽  
Nyha Class ◽  
Heart Association ◽  
Neonatal Outcomes ◽  
Fetal Mortality ◽  
Class Iii ◽  
Maternal And Neonatal Outcomes ◽  
Pregnant Mothers ◽  
Rheumatic Heart

ABSTRACT Objectives To study the maternal and neonatal outcomes of pregnancies complicated by rheumatic heart disease (RHD). Materials and methods A retrospective study was carried out in the obstetric and cardiology outpatients department of Sir Sunder Lal Hospital, Institute of Medical Sciences, Banaras Hindu University, Varanasi, India over a period of 1 year (Dec 2011-2012) involving 96 pregnant patients with rheumatic heart disease. Their maternal and fetal outcomes were reviewed. Results A total of 96 pregnant mothers with heart disease presented to us during the period of 1 year (Dec 2011-2012). Majority of the pregnant mothers had mitral stenosis n = 46 (47%). Rest of the patients had multivalve disease. Pulmonary arterial hypertension was found to be in 28 patients (29%). Atrial thrombus was seen in the echocardiography of one patient. Mitral valve replacement was done before pregnancy in 16 mothers (16%); these gravid mothers were put on low-molecular weight hepanin (LMWH) and during the midtrimester on the Acitrom. There was one patient admitted with atrial fibrillation. New York Heart Association (NYHA) class I and II heart disease progressed in two patients to class III and IV. There was no maternal or fetal mortality in this study. There were 24 cesarean sections (25%) done out of which 8 were for intrauterine growth restriction (IUGR) (32%), rest were due to maternal reasons. There were 12 preterm deliveries. Four fetuses had intraventricular hemorrhage. Conclusion Despite no maternal and neonatal mortality, pregnancy in women with heart disease is associated with significant maternal and neonatal morbidities. How to cite this article Pandey U. To Study the Maternal and Neonatal Outcomes of Pregnancies complicated by Rheumatic Heart Disease. Int J Infertil Fetal Med 2014;5(3):92-94.

scholarly journals Heart Disease and its Consequence in Pregnancy

2012 ◽  
Vol 7 (1) ◽  
pp. 7-9
Author(s):  
Fatima Wahid ◽  
Firoza Begum ◽  
Umme Kulsum ◽  
Kaniz Fatema ◽  
Farzana Sharmin ◽  
...  
Keyword(s):  
New York ◽  
Heart Disease ◽  
Prospective Observational Study ◽  
Heart Diseases ◽  
Nyha Class ◽  
Heart Association ◽  
Normal Vaginal Delivery ◽  
Class Iii ◽  
New York Heart Association ◽  
Rheumatic Heart

The aim of the study is to evaluate the types of heart disease common in our pregnant woman and to assess its influence on the maternal outcome. This was a prospective observational study. The study was carried out in the department of obstetrics & Gynecology in BSMMU from Jan 2006 to Dec 2006. Thirty-five consecutive cases with heart diseases were included in the study. Out of 35 Cases, 26(74.3%) were suffering from rheumatic heart diseases and only 9 (25.7%) patients were suffering from congenital heart disease. Based on New York heart Association (NYHA) functional classification, 28(80%) belonged to NYHA class I, 5 (71.212%) belonged to NYHA class II and 2(28.57%) belonged to class III heart disease on presentation. The number of caeserian section was 33(94.28%) and normal vaginal delivery (5.71%). In this study only 1 woman of NYHA III disease expired. DOI: http://dx.doi.org/10.3329/uhj.v7i1.10201 UHJ 2011; 7(1): 7-9

scholarly journals The American Heart Association’s Call to Action for Reducing the Global Burden of Rheumatic Heart Disease: A Policy Statement From the American Heart Association

Circulation ◽  
2020 ◽  
Vol 142 (20) ◽  
Author(s):  
Andrea Beaton ◽  
Flavia B. Kamalembo ◽  
James Dale ◽  
Joseph H. Kado ◽  
Ganesan Karthikeyan ◽  
...  
Keyword(s):  
Heart Disease ◽  
Rheumatic Heart Disease ◽  
American Heart Association ◽  
American Heart ◽  
Heart Association ◽  
World Health ◽  
Policy Statement ◽  
World Health Assembly Resolution ◽  
Worker Education ◽  
Rheumatic Heart

Rheumatic heart disease (RHD) affects ≈40 million people and claims nearly 300 000 lives each year. The historic passing of a World Health Assembly resolution on RHD in 2018 now mandates a coordinated global response. The American Heart Association is committed to serving as a global champion and leader in RHD care and prevention. Here, we pledge support in 5 key areas: (1) professional healthcare worker education and training, (2) technical support for the implementation of evidence-based strategies for rheumatic fever/RHD prevention, (3) access to essential medications and technologies, (4) research, and (5) advocacy to increase global awareness, resources, and capacity for RHD control. In bolstering the efforts of the American Heart Association to combat RHD, we hope to inspire others to collaborate, communicate, and contribute.

scholarly journals Contemporary Diagnosis and Management of Rheumatic Heart Disease: Implications for Closing the Gap: A Scientific Statement From the American Heart Association

Circulation ◽  
2020 ◽  
Vol 142 (20) ◽  
Author(s):  
Raman Krishna Kumar ◽  
Manuel J. Antunes ◽  
Andrea Beaton ◽  
Mariana Mirabel ◽  
Vuyisile T. Nkomo ◽  
...  
Keyword(s):  
Heart Failure ◽  
Heart Disease ◽  
Rheumatic Heart Disease ◽  
Treatment Options ◽  
Heart Association ◽  
Population Based ◽  
Diagnosis And Treatment ◽  
Optimal Care ◽  
Percutaneous Balloon ◽  
Rheumatic Heart

The global burden of rheumatic heart disease continues to be significant although it is largely limited to poor and marginalized populations. In most endemic regions, affected patients present with heart failure. This statement will seek to examine the current state-of-the-art recommendations and to identify gaps in diagnosis and treatment globally that can inform strategies for reducing disease burden. Echocardiography screening based on World Heart Federation echocardiographic criteria holds promise to identify patients earlier, when prophylaxis is more likely to be effective; however, several important questions need to be answered before this can translate into public policy. Population-based registries effectively enable optimal care and secondary penicillin prophylaxis within available resources. Benzathine penicillin injections remain the cornerstone of secondary prevention. Challenges with penicillin procurement and concern with adverse reactions in patients with advanced disease remain important issues. Heart failure management, prevention, early diagnosis and treatment of endocarditis, oral anticoagulation for atrial fibrillation, and prosthetic valves are vital therapeutic adjuncts. Management of health of women with unoperated and operated rheumatic heart disease before, during, and after pregnancy is a significant challenge that requires a multidisciplinary team effort. Patients with isolated mitral stenosis often benefit from percutaneous balloon mitral valvuloplasty. Timely heart valve surgery can mitigate the progression to heart failure, disability, and death. Valve repair is preferable over replacement for rheumatic mitral regurgitation but is not available to the vast majority of patients in endemic regions. This body of work forms a foundation on which a companion document on advocacy for rheumatic heart disease has been developed. Ultimately, the combination of expanded treatment options, research, and advocacy built on existing knowledge and science provides the best opportunity to address the burden of rheumatic heart disease.

scholarly journals Rheumatic heart disease in pregnancy and neonatal outcomes: A systematic review and meta-analysis

PLoS ONE ◽  
2021 ◽  
Vol 16 (6) ◽  
pp. e0253581
Author(s):  
Joshua Liaw ◽  
Betrice Walker ◽  
Leanne Hall ◽  
Susan Gorton ◽  
Andrew V. White ◽  
...  
Keyword(s):  
Heart Disease ◽  
Preterm Birth ◽  
Rheumatic Heart Disease ◽  
Perinatal Death ◽  
Meta Analysis ◽  
Heart Association ◽  
Fetal Outcomes ◽  
Percutaneous Balloon ◽  
Rheumatic Heart ◽  
In Pregnancy

Purpose Associations between rheumatic heart disease (RHD) in pregnancy and fetal outcomes are relatively unknown. This study aimed to review rates and predictors of major adverse fetal outcomes of RHD in pregnancy. Methods Medline (Ovid), Pubmed, EMcare, Scopus, CINAHL, Informit, and WHOICTRP databases were searched for studies that reported rates of adverse perinatal events in women with RHD during pregnancy. Outcomes included preterm birth, intra-uterine growth restriction (IUGR), low-birth weight (LBW), perinatal death and percutaneous balloon mitral valvuloplasty intervention. Meta-analysis of fetal events by the New-York Heart Association (NYHA) heart failure classification, and the Mitral-valve Area (MVA) severity score was performed with unadjusted random effects models and heterogeneity of risk ratios (RR) was assessed with the I2 statistic. Quality of evidence was evaluated using the GRADE approach. The study was registered in PROSPERO (CRD42020161529). Findings The search identified 5949 non-duplicate records of which 136 full-text articles were assessed for eligibility and 22 studies included, 11 studies were eligible for meta-analyses. In 3928 pregnancies, high rates of preterm birth (9.35%-42.97%), LBW (12.98%-39.70%), IUGR (6.76%-22.40%) and perinatal death (0.00%-9.41%) were reported. NYHA III/IV pre-pregnancy was associated with higher rates of preterm birth (5 studies, RR 2.86, 95%CI 1.54–5.33), and perinatal death (6 studies, RR 3.23, 1.92–5.44). Moderate /severe mitral stenosis (MS) was associated with higher rates of preterm birth (3 studies, RR 2.05, 95%CI 1.02–4.11) and IUGR (3 studies, RR 2.46, 95%CI 1.02–5.95). Interpretation RHD during pregnancy is associated with adverse fetal outcomes. Maternal NYHA III/IV and moderate/severe MS in particular may predict poor prognosis.

scholarly journals Maternal and Neonatal Outcomes of Pregnancies in Women With Congenital Heart Disease: A Meta‐Analysis

2021 ◽  
Author(s):  
Isabel Hardee ◽  
Lydia Wright ◽  
Courtney McCracken ◽  
Emily Lawson ◽  
Matthew E. Oster
Keyword(s):  
Congenital Heart Disease ◽  
Heart Disease ◽  
Neonatal Mortality ◽  
Congenital Heart ◽  
Meta Analysis ◽  
Neonatal Outcomes ◽  
Successful Outcome ◽  
Fetal Mortality ◽  
Maternal And Neonatal Outcomes ◽  
Modern Era

Background With advances in the treatment of congenital heart disease (CHD), more women with CHD survive childhood to reach reproductive age. The objective of this study was to evaluate the maternal and neonatal outcomes of pregnancies among women with CHD in the modern era. Methods and Results We conducted a meta‐analysis of peer‐reviewed literature published January 2007 through June 2019. Studies were included if they reported on maternal or fetal mortality and provided data by CHD lesion. Meta‐analysis was performed using random effect regression modeling using Comprehensive Meta‐Analysis (v3). CHD lesions were categorized as mild, moderate, and severe to allow for pooling of data across studies. Of 2200 articles returned by our search, 32 met inclusion criteria for this study. Overall, the rate of neonatal mortality was 1%, 3.1%, and 3.5% in mild, moderate, and severe lesions, respectively. There were too few maternal deaths in any group to pool data. The rates of maternal and neonatal morbidity among women with CHD increase with severity of lesion. Specifically, rates of maternal arrhythmia and heart failure, cesarean section, preterm birth, and small for gestational age neonate are all markedly increased as severity of maternal CHD increases. Conclusions In the modern era, pregnancy in women with CHD typically has a successful outcome in both mother and child. However, as maternal CHD severity increases, so too does the risk of numerous morbidities and neonatal mortality. These findings may help in counseling women with CHD who plan to become pregnant, especially women with severe lesions.

Early Experience With Sacubitril/Valsartan in Adult Patients With Congenital Heart Disease

2019 ◽  
Vol 10 (3) ◽  
pp. 292-295 ◽  
Author(s):  
Gentian Lluri ◽  
Jeannette Lin ◽  
Leigh Reardon ◽  
Pamela Miner ◽  
Katrina Whalen ◽  
...  
Keyword(s):  
New York ◽  
Congenital Heart Disease ◽  
Pulmonary Hypertension ◽  
Heart Disease ◽  
Congenital Heart ◽  
Adult Congenital Heart Disease ◽  
Nyha Class ◽  
Heart Association ◽  
Class Ii ◽  
Class Iii

Background: Heart failure (HF) is the leading cause of hospitalizations and death in patients with adult congenital heart disease (ACHD). Sacubitril/valsartan is a new agent in the treatment of HF, but its effects have not been assessed in ACHD. Methods: We retrospectively studied all 15 patients with ACHD at our center who were prescribed sacubitril/valsartan between June 2017 and June 2018. We assessed baseline characteristics and clinical and laboratory changes after initiation of sacubitril/valsartan. Adverse events, including renal function, medication intolerance, and worsening HF were documented. Results: The median age was 53.2 (27.6-83.6) years, with a median follow-up duration of 69 (8-419) days. At baseline, all patients had refractory HF despite guideline-directed medical therapy, with ten (67%) patients as New York Heart Association (NYHA) class II, and five (33%) patients NYHA class III. The medication was discontinued in one (7%) patient secondary to worsening kidney function. No patients reported clinical deterioration; four NYHA class III patients with complex CHD, pulmonary hypertension, and cyanosis reported significant improvement to NYHA class II. Baseline creatinine was 1.1 (0.9-1.7) and two weeks after starting sacubitril/valsartan it was 1.3 (0.8-2.5, P = .22). Conclusions: Sacubitril/valsartan seems to be well tolerated in patients with ACHD who present with refractory HF symptoms. Patients with complex CHD associated with cyanosis and pulmonary hypertension could benefit the most, but larger studies are needed to assess the safety as well as the effectiveness of sacubitril/valsartan in this patient population.

scholarly journals Chronic rheumatic heart disease and congenital heart disease complicating pregnancy: a study of the cardiac events, the maternal and perinatal outcome during 2011-2013 at tertiary care centre

2020 ◽  
Vol 9 (7) ◽  
pp. 2736
Author(s):  
Pratibha Devabhaktuni ◽  
Sushma Manchala ◽  
Somaraju Bhupathi Raju ◽  
Rajeev Menon ◽  
C. Sridevi
Keyword(s):  
Congenital Heart Disease ◽  
Heart Disease ◽  
Rheumatic Heart Disease ◽  
Perinatal Outcome ◽  
Congenital Heart ◽  
Nyha Class ◽  
Prosthetic Heart Valve ◽  
Heart Team ◽  
Eisenmenger’S Syndrome ◽  
Rheumatic Heart

Background: Objective of this study was to assess the prevalence of chronic rheumatic heart disease and congenital heart disease complicating pregnancy, study the maternal and perinatal outcome, and indications for termination of pregnancy.Methods: Preconception counseling, antenatal care by pregnancy heart team as per protocol. One 2nd gravida (G2A1) with 26 weeks gestation, underwent mitral valve replacement during 26th week gestation i/v/o infective endocarditis associated with severe mitral regurgitation.Results: Authors had CRHD: CHD = 29:21, out of 50 cases, the ratio was 1.3:1 in this study. Atrial septal defect (ASD) was the predominant lesion in this study -29% ASD alone and 9% associated with pulmonary artery hypertension. Eisenmenger's syndrome, was associated with ASD in three and VSD in two. Corrected lesions were 24%. In the rheumatic heart disease, mitral stenosis was the predominant lesion and PBMV was done in four (13.7%) cases. In CRHD cases, surgically corrected by prosthetic heart valve were -11 (37.9%). In CRHD total corrected cases, by prosthetic heart valve and percutaneous balloon mitral valvotomy (PBMV) account for 51.7%. One patient had PBMV procedure during 5th month of present pregnancy i/v/o severe mitral stenosis with mitral valve area -0.8 cm2 and another patient had PBMV during her first pregnancy. In this study 42% were in NYHA class I. 14% were in NYHA class IV. CHF was seen in 10%. Termination of pregnancy was necessary in 6 with CHD and 5 with CRHD. There were 39 deliveries with one set of twins. All the babies were alive. Maternal mortality was confirmed in one case with Eisenmenger’s syndrome + HELLP syndrome. Live birth rate was higher in cases with NYHA class I/II than in those with NYHA class III/IV (82.8% versus 66.60%).Conclusions: Management by a pregnancy heart team as per guidelines would reduce mortality.

scholarly journals The Human Leukocyte Antigen Locus and Susceptibility to Rheumatic Heart Disease in South Asians and Europeans

2019 ◽  
Author(s):  
Kathryn Auckland ◽  
Balraj Mittal ◽  
Benjamin J Cairns ◽  
Naveen Garg ◽  
Surendra Kumar ◽  
...  
Keyword(s):  
Heart Disease ◽  
Amino Acid ◽  
Human Leukocyte Antigen ◽  
Rheumatic Heart Disease ◽  
South Asians ◽  
Human Leukocyte ◽  
Class Iii ◽  
Leukocyte Antigen ◽  
Genome Wide ◽  
Rheumatic Heart

AbstractBackgroundRheumatic heart disease (RHD) remains an important cause of morbidity and mortality globally. Several reports have linked the disease to the human leukocyte antigen (HLA) locus but with negligible consistency.MethodsWe undertook a genome-wide association study (GWAS) of susceptibility to RHD in 1163 South Asians (672 cases; 491 controls) recruited in India and Fiji. We analysed directly obtained and imputed genotypes, and followed-up associated loci in 1459 Europeans (150 cases; 1309 controls) from the UK Biobank study. For fine-mapping, we used HLA imputation to define classical alleles and amino acid polymorphisms.ResultsA single signal situated in the HLA class III region reached genome-wide significance in the South Asians, and replicated in the Europeans (rs201026476; combined odds ratio 1.81, 95% confidence intervals 1.51-2.18, P=3.48×10−10). While the signal fine-mapped to specific amino acid polymorphisms within HLA-DQB1 and HLA-B, with conditioning, the lead class III variant remained associated with susceptibility (P=3.34×10−4), suggesting an independent effect.ConclusionsA complex HLA signal, likely comprising at least two underlying causal variants, strongly associates with susceptibility to RHD in South Asians and Europeans. Crucially, the involvement of the class III region may partly explain the previous inconsistency, while offering important new insight into pathogenesis.

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