A pregnant woman with congenital heart disease complicated by endocarditis.
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ABSTRACT:
SUBMITTER: Chen D
PROVIDER: S-EPMC9204469 | biostudies-literature | 2022 Jun
REPOSITORIES: biostudies-literature
Publications
A pregnant woman with congenital heart disease complicated by endocarditis.
Chen Dandan D Huang Wenying W Wang Yi Y Wang Bin B
European heart journal. Case reports 20220606 6
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Project description:In this article, we introduced a case of rare congenital anomalies that was asymptomatic until adulthood and was complicated by infective endocarditis and dissection of aortic valve leaflet.
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Project description:BackgroundCongenital heart disease (CHD) is one of the most important and common group of congenital malformations in humans. Concurrent development and close functional links between the fetal heart and placenta emphasise the importance of understanding placental function and its influence in pregnancy outcomes. The aim of this study was to evaluate placental oxygenation by relaxometry (T2*) to assess differences in placental phenotype and function in CHD.MethodsIn this prospective cross-sectional observational study, 69 women with a fetus affected with CHD and 37 controls, whole placental T2* was acquired using a 1.5-Tesla MRI scanner. Gaussian Process Regression was used to assess differences in placental phenotype in CHD cohorts compared to our controls.ResultsPlacental T2* maps demonstrated significant differences in CHD compared to controls at equivalent gestational age. Mean T2* values over the entire placental volume were lowest compared to predicted normal in right sided obstructive lesions (RSOL) (Z-Score 2.30). This cohort also showed highest lacunarity indices (Z-score -1.7), as a marker of lobule size. Distribution patterns of T2* values over the entire placental volume were positively skewed in RSOL (Z-score -4.69) and suspected, not confirmed coarctation of the aorta (CoA-) (Z-score -3.83). Deviations were also reflected in positive kurtosis in RSOL (Z-score -3.47) and CoA- (Z-score -2.86).ConclusionPlacental structure and function appear to deviate from normal development in pregnancies with fetal CHD. Specific patterns of altered placental function assessed by T2* deliver crucial complementary information to antenatal assessments in the presence of fetal CHD.
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Project description:With increasing atrial septal defect (ASD) repairs, more women of childbearing age will have ASD closure devices. Current ASD closure trials have excluded women planning pregnancy, making their management challenging. We present a pregnant woman, with a repaired ASD, who presented with device-related infective endocarditis. (Level of Difficulty: Beginner.).
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Project description:BackgroundInfective endocarditis (IE) is a major issue during follow-up of adults with congenital heart disease (ACHD), leading to significant mortality.Case summaryA 37-year-old woman with transposition of great arteries and previous Mustard operation developed a drug-resistant pneumonia shortly after a pacemaker implant procedure performed at a local hospital. After referral to the ACHD centre, the patient was diagnosed with multivalvular IE with biventricular involvement by methicillin-resistant Staphylococcus aureus. On admission, the patient was already in acute respiratory distress and presented both systemic and pulmonary embolization. Despite adequate treatment was promptly started, the patient developed multiorgan failure.DiscussionThis case depicts a particularly aggressive of infective endocarditis forms caused with biventricular involvement and multiple embolization. Patients with congenital heart disease are at high risk of IE with adverse impact on the prognosis. Early recognition and treatment are the keys to improve prognosis. Therefore, suspicion should be high, especially following invasive procedure, which should be preferably performed at ACHD specialized centres.
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Project description:ObjectiveTo estimate nationwide trends in the prevalence of maternal congenital heart disease (CHD) and determine whether women with CHD are more likely than women without maternal CHD to have medical and obstetric complications.MethodsThe 2000-2010 Nationwide Inpatient Sample was queried for International Classification of Diseases, 9th Revision, Clinical Modification codes to identify delivery hospitalizations of women with and without CHD. Trends in the prevalence of CHD were determined and then rates of complications were reported for CHD per 10,000 delivery hospitalizations. For Nationwide Inpatient Sample 2008-2010, logistic regression was used to examine associations between CHD and complications.ResultsFrom 2000 to 2010, there was a significant linear increase in the prevalence of CHD from 6.4 to 9.0 per 10,000 delivery hospitalizations (P<.001). Multivariable logistic regression demonstrated that all selected medical complications, including mortality (17.8 compared with 0.7/10,000 deliveries, adjusted odds ratio [OR] 22.10, 95% confidence interval [CI] 13.96-34.97), mechanical ventilation (91.9 compared with 6.9/10,000, adjusted OR 9.94, 95% CI 7.99-12.37), and a composite cardiovascular outcome (614 compared with 34.3/10,000, adjusted OR 10.54, 95% CI 9.55-11.64) were more likely to occur among delivery hospitalizations with maternal CHD than without. Obstetric complications were also common among women with CHD. Delivery hospitalizations with maternal CHD that also included codes for pulmonary circulatory disorders had higher rates of medical complications compared with hospitalizations with maternal CHD without pulmonary circulatory disorders.ConclusionThe number of delivery hospitalizations with maternal CHD in the United States is increasing, and although we were not able to determine whether correction of the cardiac lesion affected outcomes, these hospitalizations have a high burden of medical and obstetric complications.Level of evidenceII.
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Project description:We present the case of an adult patient with Kartagener's syndrome, multiple prior sternotomies, and recurrent prosthetic valve endocarditis, a scenario without clear guidelines to direct management. Ultimately, the team elected for medical management given the high mortality risk associated with surgery; the patient responded to antibiotic therapy.
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Project description:A child with repaired double outlet right ventricle presented with Staphylococcus aureus bacteremia. Despite unsuspecting echocardiography on admission and clinical improvement on antibiotics, repeat routine echocardiography detected an aortic pseudoaneurysm, requiring a Ross-Konno operation. In repaired congenital heart defects with bacteremia, close echocardiographic surveillance is required to detect aortic pseudoaneurysm. (Level of Difficulty: Intermediate.).
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Project description:Background Women with congenital heart disease are considered at high risk for adverse events. Therefore, we aim to establish 2 prediction models for mothers and their offspring, which can predict the risk of adverse events occurred in pregnant women with congenital heart disease. Methods and Results A total of 318 pregnant women with congenital heart disease were included; 213 women were divided into the development cohort, and 105 women were divided into the validation cohort. Least absolute shrinkage and selection operator was used for predictor selection. After validation, multivariate logistic regression analysis was used to develop the model. Machine learning algorithms (support vector machine, random forest, AdaBoost, decision tree, k-nearest neighbor, naïve Bayes, and multilayer perceptron) were used to further verify the predictive ability of the model. Forty-one (12.9%) women experienced adverse maternal events, and 93 (29.2%) neonates experienced adverse neonatal events. Seven high-risk factors were discovered in the maternal model, including New York Heart Association class, Eisenmenger syndrome, pulmonary hypertension, left ventricular ejection fraction, sinus tachycardia, arterial blood oxygen saturation, and pregnancy duration. The machine learning-based algorithms showed that the maternal model had an accuracy of 0.76 to 0.86 (area under the receiver operating characteristic curve=0.74-0.87) in the development cohort, and 0.72 to 0.86 (area under the receiver operating characteristic curve=0.68-0.80) in the validation cohort. Three high-risk factors were discovered in the neonatal model, including Eisenmenger syndrome, preeclampsia, and arterial blood oxygen saturation. The machine learning-based algorithms showed that the neonatal model had an accuracy of 0.75 to 0.80 (area under the receiver operating characteristic curve=0.71-0.77) in the development cohort, and 0.72 to 0.79 (area under the receiver operating characteristic curve=0.69-0.76) in the validation cohort. Conclusions Two prenatal risk assessment models for both adverse maternal and neonatal events were established, which might assist clinicians in tailoring precise management and therapy in pregnant women with congenital heart disease.
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