Cardiac Disease in Pregnancy: Maternal and Perinatal Outcomes in RSUP Dr. Mohammad Hoesin Palembang

Background: Impaired maternal and uteroplacental perfusion can occur in pregnancy with cardiac disease leading to maternal and perinatal mortality and morbidity due to increased cardiac load and ventricular dysfunction. This research aims to determine maternal and perinatal outcomes of pregnancies with cardiac disease. Method: This research was a descriptive observational study conducted by a total sampling method and a cross-sectional design. This research used medical records of pregnant women with cardiac disease who gave birth in RSUP Dr. Mohammad Hoesin Palembang in January 2018-December 2020 as study samples. Result: Among 68 pregnancies with cardiac disease, there were 4 cases (0.87%) found in 2018, 37 cases (2.47%) found in 2019, and 27 cases (1.48%) found in 2020. The highest distribution of pregnancies with cardiac disease was found at 64.7% in the range of 20-35 years old age group; 57.4% in the multiparity group; 38.2% in the range of ≥34 – <37 weeks gestational age group; 86.8% in the high school educational level group; 66.2% in the high-risk cardiac functional status group; 54.4% in the peripartum cardiomyopathy group; and 36.8% with preeclampsia/eclampsia as a comorbid. In this study, maternal outcomes found were maternal mortality at 11.8%; cardiac failure at 70.6%; arrhythmia at 1.5%; and stroke at 1.5%, while perinatal outcomes found were prematurity at 60.3%; low birth weight at 64.4%; IUGR at 37.0%; IUFD at 1.4%; stillbirth at 6.8%; neonatal death at 9.6%; and perinatal asphyxia at 42.5%. Conclusion: The prevalence rate of pregnancies with cardiac disease in RSUP Dr. Mohammad Hoesin Palembang was 0.87% in 2018, 2.47% in 2019, and 1.48% in 2020. The most common maternal outcome in this study was cardiac failure, with most in the peripartum cardiomyopathy group, while the most common perinatal outcome was low birth weight, with most in the hypertensive heart disease group.

Noncompaction of left ventricle - a rare cardiomyopathy

Non-compaction of left ventricular (NCLV) is a rare cardiomyopathy of unknown origin characterized by prominent ventricular trabeculations and deep intertrabecular sinusoids, in communication with the left ventricular cavity. The NCLV results due to failure of compaction during foetal development. In this study, five children were diagnosed with NCLV out of 135 cases of cardiomyopathy and the youngest case was diagnosed at 27th day of life. Congestive cardiac failure presenting as tachycardia and tachypnea were common clinical manifestations. Early detection of NCLV helps patients to get timely treatment. NCLV should be considered as one of the differential diagnosis amongst cases of cardiomyopathy.

Comprehensive Analysis of Bortezomib-Induced Adverse Events Using the Japanese Real-World Database

Background: Bortezomib is used as first-line therapy for multiple myeloma. Observational studies based on the FDA Adverse Event Reporting System (FAERS) database analysis and systematic reviews indicate that the incidence of peripheral neuropathy and tumor lysis syndrome (TLS) tends to be higher with bortezomib than that of other drugs. In a comprehensive analysis assessing drugs that cause peripheral neuropathy in Japanese patients, the incidence of bortezomib-induced adverse events (AEs) was reportedly high. However, a comprehensive assessment of bortezomib is lacking. Objectives: The purpose of this study was to determine the frequency of bortezomib AEs in Japanese patients and to determine the incidence, time to onset, and post hoc outcomes of unique AEs using the Japanese Adverse Drug Event Report (JADER) database. Method: To investigate the association between bortezomib and AEs, we analyzed the JADER database, which contains spontaneous AE reports submitted to the Pharmaceuticals and Medical Devices Agency from April 2004 to December 2020. Criteria indicating the presence of an AE signal were met when the following requirements were fulfilled: proportional reporting ratios (PRR) ≥ 2 and χ2 ≥ 4. Time to onset and post-event outcomes were analyzed for characteristic AEs. Results: Among 26 extracted AEs, 13 presented AE signals. The post-exposure outcomes of 12 AEs showed fatal outcomes at rates exceeding 10%, including cardiac failure (30%), lung disorder (24%), pneumonia (18%), and TLS (10%). Furthermore, a histogram of time to onset revealed that the 12 AEs were concentrated from the beginning to approximately one month after bortezomib administration. The median onset times for cardiac failure, lung disorder, pneumonia, and TLS were 28, 13, 42, and 5 days, respectively. Conclusions: Cardiac failure, lung disorder, pneumonia, and TLS had a higher rate of fatal clinical outcomes after onset than other AEs. These AEs exhibited a greater onset tendency in the early post-dose period. This study suggests that there is a need to monitor signs of cardiac failure, lung disorder, pneumonia, and TLS, potentially resulting in serious outcomes.

Rare Case of Chagas Disease

Chagas is a multisystem disease transmitted from Trypanosoma cruiz, not uncommon in Latin America. This disease causes parasympathetic failure resulting in cardiac failure, arrhythmogenic, cardiomyopathy, sudden death, mega esophagus and mega colon. In this article, we present a case of chronic Chagas disease who had extensive investigation prior to reaching a correct diagnosis. We will highlight the symptomatology and treatment.

A game of Whack-A-Mole: closing multiple ventricular septal defects

Multiple ventricular septal defects (m-VSD), are a challenging clinical problem. m-VSD can be onerous to manage. Besides the inability to close all the defects in one operative setting due to inadequate visualization, previously undetected defects may become clinically apparent after the closure of the dominant defects, leading to inadequate ventricular septation. This increases the morbidity from the progression of pulmonary hypertension, persistence of congestive cardiac failure, higher incidence of postoperative heart block, and the need for reoperations.

Mesothelioma with Nonbacterial Thrombotic Endocarditis: A Case Report

Non-bacterial thrombotic endocarditis is a rare condition characterized by noninfectious vegetation on cardiac valves which are often associated with malignancy. It often presents with features of embolism rather than cardiac failure. These are usually seen in autoimmune conditions, disseminated intravascular coagulation, malignancy of gut and lung but has also been reported in other malignancies as well. This entity is rare but one must have a clinical suspicion of the disease especially in a patient suffering from malignancy presenting with the embolic phenomenon. In this report, we are presenting a case of non-bacterial thrombotic endocarditis in an inpatient with pleural mesothelioma, a rare malignant neoplasm arising from pleura in a 35 years old mason, and a rare association as well.

Predictors of Short- and Long-Term Mortality in Ischemic Stroke: A Community-Based Study in Brno, Czech Republic

<b><i>Background and Objective:</i></b> Short- and long-term mortality following ischemic stroke (IS) and their predictors have not been defined in the Czech population, and studies on long-term mortality are largely missing for the populations of Central Europe. <b><i>Methods:</i></b> Using the National Register of Hospitalized Patients and the Czech National Mortality Registry, we analyzed data on 1-month, 1-year, and 3-year all-cause mortality for patients admitted with IS to any of the 4 hospitals with a certified stroke unit in Brno, Czech Republic, in 2011. We reviewed discharge summaries and recorded potential factors impacting mortality after the index stroke event. Using univariate and multivariable analyses, we identified predictors of mortality at all 3 time points. <b><i>Results:</i></b> In our multivariable model, statin use (odds ratio [OR] 0.095, <i>p</i> &#x3c; 0.0001), age at stroke (OR 1.03, <i>p</i> = 0.0445), and admission National Institutes of Health Stroke Scale (NIHSS) score (OR 1.16, <i>p</i> &#x3c; 0.0001) predicted 1-month mortality, while statin use (OR 0.43, <i>p</i> = 0.0004), history of cardiac failure (OR 2.17, <i>p</i> = 0.0137), age at stroke (OR 1.07, <i>p</i> &#x3c; 0.0001), and admission NIHSS score (OR 1.14, <i>p</i> &#x3c; 0.0001) predicted 1-year mortality. Statin use (OR 0.54, <i>p</i> = 0.0051), history of cardiac failure (OR 2.13, <i>p</i> = 0.0206), age at stroke (OR 1.07, <i>p</i> &#x3c; 0.0001), and admission NIHSS score (OR 1.11, <i>p</i> &#x3c; 0.0001) also predicted 3-year mortality. <b><i>Conclusions:</i></b> Our study is the first to report data on short- and long-term mortality rates and their predictors in patients hospitalized with IS in the Czech population. Our results indicate that mortality rates and predictors of mortality are consistent with those reported in studies from other populations throughout the world.

Salvage of a megafistula causing high-output cardiac failure in a young adult with aneurysmorrhaphy and banding

We present the case of a 21-year-old male with significant lengthening and aneurysmal degeneration of his brachiocephalic arteriovenous fistula resulting in a megafistula and high-output cardiac failure. A computed tomography angiogram showed narrowing at the cephalic arch. Further evaluation during the operation revealed kinking and elongation of the fistula in addition to compression of the cephalic arch in the deltopectoral groove leading to outflow obstruction. The aneurysmal fistula was treated successfully with aneurysmorrhaphy of the remaining conduit and banding of the inflow. This case demonstrates a unique etiology of venous outflow obstruction for a fistula and describes the surgical approach to its treatment in a young patient suffering from cardiac failure.