Maternal and perinatal outcomes of pregnancies complicated by cardiac disease at a tertiary level hospital

Heart disease in pregnancy is one of the leading non-obstetric causes of maternal mortality and is the leading cause of maternal intensive care unit admissions in the world. To study the prevalence of heart disease in antenatal mothers and fetal outcome with obstetric management. The presence of comorbidities and the occurrence of obstetric, fetal, and cardiovascular complications during delivery among women with heart disease hospitalized for delivery were studied in 35 women at GSL Medical College, Rajahmundry for a period of 1 year from 01/01/2019 to 1/1/2020: Over a period of 12 months, 35 subjects were recruited. During this period, there were 5005 deliveries. The majority of women were aged between 20-25yrs and were unbooked cases belonging to NYHA class I or II. Cesarean section and operative vaginal delivery were more common. Despite the multidisciplinary approach, 3 women succumbed to the disease of which one was a case of severe rheumatic heart disease with valve failure, the second was a case of postpartum cardiomyopathy and the third was a case of severe pulmonary arterial hypertension. Fetal outcome in cardiac patients is usually good and only a little different from those patients who do not suffer from heart disease. Pregnant women with heart disease were more likely to experience adverse events during delivery. These women require a multidisciplinary team for optimal maternal and foetal outcomes.

Case Report: Non-episodic Angioedema With Eosinophilia in a Young Lactating Woman

Angioedema with eosinophilia is classified into two types: episodic angioedema with eosinophilia (EAE), known as Gleich’s syndrome, and non-episodic angioedema with eosinophilia (NEAE). We present the case of a young lactating woman with non-episodic angioedema. She had no history of parasitic or nonparasitic infections. Physical examination showed striking, non-pitting edema in both lower extremities. Her weight had not changed significantly throughout the course of the illness. She exhibited no other symptoms, and her vital signs were normal. There was no evidence of anemia, hypoalbuminemia, thyroid dysfunction, heart failure, renal failure, or postpartum cardiomyopathy. Based on these findings, we diagnosed her with angioedema with eosinophilia. Given the scarcity of information about this condition, we explored the dynamics between cytokines/chemokines and edema in this patient. We successfully quantified the edema by bioimpedance analysis. In addition, we revealed the involvement of interleukin-5 (IL-5), thymus- and activation-regulated chemokine/C-C motif chemokine ligand-17 (TARC/CCL-17), eotaxin-3/CCL-26, tumor necrosis factor-α (TNF-α), vascular endothelial growth factor (VEGF), monocyte chemotactic protein-4/CCL-13 (MCP-4/CCL-13), eotaxin-1/CCL-11, and regulated on activation, normal T expressed and secreted/CCL-5 (RANTES/CCL-5) in NEAE. Lastly, we elucidated the strong association between these parameters. To the best of our knowledge, this is the first such study of its kind.

Severe acute respiratory syndrome coronavirus-2- or pregnancy-related cardiomyopathy, a differential to be considered in the current pandemic: a case report

Background There are limited data on cardiovascular complications of coronavirus disease 2019 in pregnancy, and there are only a few case reports on coronavirus disease 2019 related cardiomyopathy in pregnancy. Differentiation between postpartum cardiomyopathy and coronavirus disease 2019 related cardiomyopathy in pregnant women who develop severe acute respiratory syndrome coronavirus-2 infection during peripartum could be challenging. Here, we present a case of possible coronavirus disease 2019 related cardiomyopathy in a pregnant patient, followed by a discussion of potential differential diagnosis. Case presentation In this case report, we present the case of a young pregnant Iranian woman who developed heart failure with pulmonary edema after cesarean section. She was treated because of low left ventricular ejection fraction and impression of postpartum cardiomyopathy, and her severe dyspnea improved by intravenous furosemide. On day 3, she exhibited no orthopnea or leg edema, but she was complaining of severe and dry cough. Further evaluation showed severe acute respiratory syndrome coronavirus-2 infection. Conclusions The possibility of severe acute respiratory syndrome coronavirus-2 infection should be considered in any pregnant woman who develops cardiomyopathy and pulmonary edema.

Abstract 454: Modeling FLNC Mutations Causing Cardiomyopathy

Genetic mutations lead to cardiomyopathy, a condition linked to heart failure and arrhythmias.Mutations in the FLNC gene have recently been reported in multiple forms of cardiomyopathyincluding dilated, hypertrophic and restrictive forms. The FLNC gene encodes filamin C, anactin-binding protein highly expressed in the heart and skeletal muscle. Filamin C is comprisedof three domains: an actin-binding domain at the N-terminus, a rod domain consisting of 24 Igrepeats in the mid region, and a dimerization domain at the C-terminus. Missense mutations in FLNC have also been described in myofibrillar myopathy, a disorder in skeletal musclecharacterized by intracellular aggregates within muscle. Where examined, FLNC mutant heartsdo not have evident protein aggregation leading to the hypothesis that FLNC mutations havedifferent modes of action in skeletal and cardiac muscle. We identified a FLNC Val2715fs87Xmutation in a 55 yo M with cardiac fibrosis and a history of arrhythmias. We found a second FLNC mutation, Glu2458SerfsX71, which was found in a family with sudden death andhypertrophic cardiomyopathy. A third FLNC mutation, Arg650X, was found in a 41 yo F withhistory of postpartum cardiomyopathy; this patient also harbors a second FLNC variant ofuncertain significance, intron 5, c.970-4A>G (Intronic), which is predicted to affect splicing onher other FLNC allele. Notably, this patient was diagnosed with a muscle disorder in early life.Finally, a fourth FLNC variant, Phe106Leu, found in two brothers with skeletal and cardiacmyopathy was also studied. To examine the mechanisms by which FLNC mutations causecardiomyopathy, we generated patient-derived induced pluripotent stem cells (iPSCs) anddifferentiated these cell lines into cardiomyocytes. Cardiomyocyte function was analyzed usingautomated field potential measurements with the Nanion CardioExcyte. We identified a slowerrate of repolarization with FLNC truncations compared to control. These data demonstrate thepathogenic findings associated with FLNC mutations and provide mechanistic insight intocardiomyopathy and arrhythmias resulting from these mutations.

Obstetrical causes of maternal mortality. Results of pathoanatomical examinations

Objective. To study the main causes of maternal mortality and to determine the role of obstetrical pathologies based on the findings of pathoanatomical autopsies. Materials and methods. The study included 42 autopsy findings, we studied medical documentation, autopsy records of deceased pregnant and parturient women. The most common causes of mortality (n = 29), according to the latest revision of ICD-10, were analyzed in detail. The general clinical and morphological examination was performed. Results. In Moscow, more than half of cases in the structure of maternal mortality refer to obstetrical pathologies. The most significant role belongs to preeclampsia and eclampsia (28.6%), they are in most cases characterised by an atypical clinical course and a specific pathomorphological picture. The second place is taken by massive pulmonary embolism (9.5%), the third place belongs to maternal shock during labour (7%) and the fourth place is shared by intrapartum infection (obstetrical sepsis), complications associated with obstetrical operative intervention and procedures, postpartum cerebral venous thrombosis, amniotic fluid embolism, postpartum cardiomyopathy (4.8%). Conclusion. The leading position in the structure of maternal mortality due to obstetrical causes belongs to preeclampsia and eclampsia. This pathology requires a complex approach to diagnosis and treatment, and postmortem verification of diagnosis should be confirmed by morphological examination with the use of immunohistochemical reactions. Key words: maternal mortality, obstetric pathology, preeclampsia and eclampsia, pulmonary embolism, maternal shock, obstetrical sepsis