December

Pregnancy Outcomes in Women After Arterial Switch Operation for Transposition of the Great Arteries: Results From ROPAC (Registry of Pregnancy and Cardiac Disease) of the European Society of Cardiology EURObservational Research Programme

Pregnancy Outcomes in Women After Arterial Switch Operation for Transposition of the Great Arteries: Results From ROPAC (Registry of Pregnancy and Cardiac Disease) of the European Society of Cardiology EURObservational Research Programme Tutarel O, Ramlakhan KP, Baris L, Subirana MT, Bouchardy J, Nemes A, Vejlstrup NG, Osipova OA, Johnson MR, Hall R, Roos-Hesselink JW; ROPAC (Registry of Pregnancy and Cardiac Disease) Investigators Group *.J Am Heart Assoc. 2021 Jan 5;10(1):e018176. doi: 10.1161/JAHA.120.018176. Epub 2020 Dec 22.PMID: 33350866 Free article.   Take Home Points: Women with Transposition of the Great Arteries post arterial switch operation can be reassured that pregnancy is safe with a low risk of maternal cardiac complications. Similar to other cardiac pregnancies, premature delivery (17.1%) and low birth weight (14.6%) are the most significant fetal complications. The impact of pregnancy on maternal valvular and ventricular function in the TGA post arterial switch population remains unknown.   Commentary from Dr. Jasmine Grewal (Vancouver, BC, Canada), section editor of Cardio-Obstetrics Journal Watch: This prospective study reports the maternal and fetal outcomes of 41 pregnancies in women with Transposition of the Great Arteries post arterial switch from the ROPAC (Registry of Pregnancy and Cardiac Disease) of the European Society of Cardiology EURObservational Research Program. Data on pregnancy outcomes in this population have been limited and hence no formal risk stratification in the modified WHO classification. Of the 5739 patients included in the ROPAC registry between 2007-2018, 41 were post arterial switch. As compared to the rest of the cohort in which 40% were from an emerging country, 5% in the study group were from an emerging country. The vast majority (97.6%) were NYHA I/II and 24% were on a cardiac medication pre-pregnancy. Maternal outcomes were very good with no maternal mortality during pregnancy and up to 6 months post-partum. A major cardiovascular event occurred in 2 women (5%): one acute heart failure admission thought to be related to reduced systemic ventricular function and one ventricular tachycardia treated with beta-blockers as an outpatient. One fetal loss was reported with no neonatal loss. Other fetal complications of premature birth (17%) and low birth weight (14.6%) were not statistically different than the rest of the ROPAC cohort. The current study is reassuring with favorable maternal and fetal outcomes in this population. However, there is limited data available on the trajectory of valve and ventricular function over the course of pregnancy and into the post-partum period.   

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Fatality rates and use of systemic thrombolysis in pregnant women with pulmonary embolism

Fatality rates and use of systemic thrombolysis in pregnant women with pulmonary embolism. Hobohm L, Keller K, Valerio L, Ni Ainle F, Klok FA, Münzel T, Kucher N, Lankeit M, Konstantinides SV, Barco S.ESC Heart Fail. 2020 Oct;7(5):2365-2372. doi: 10.1002/ehf2.12775. Epub 2020 Jun 21.PMID: 32567197 Free PMC article.   Take Home Points: Pulmonary embolism has a high mortality rate in pregnant women. Even with thrombolysis once there is haemodynamic compromise there were very high mortality rates. Pulmonary embolism is a common problem pregnancy, complicating 2.2 cases per 10,000 pregnancies and represents 14% of all maternal deaths. Commentary from Dr. Reza Ashrafi (Vancouver, BC, Canada), section editor of Cardio-Obstetrics Journal Watch:   Methods A retrospective analysis of 11 years’ worth of inpatient data from the German national inpatient registry. All pregnant patients were analysed and identified if they had been coded for pulmonary embolism (PE) or obstetric thromboembolism. Administrative data records were then reviewed for management and outcomes from the embolism or thromboembolic event including haemodynamic failure, thrombolysis and maternal death.   Results Over an 11 year period there 8,271,327 livebirths and 1846 hospitalisations with pregnancy associated pulmonary embolism with a median maternal age of 31. Median inpatient stay was 8 days. Overall there was a downward trend in the incidence and mortality of PE during the timeframe of the study (Figure 1).     There was a significant increase in the incidence of PE in the final 4 weeks of pregnancy and in patients who had surgery during their in-hospital stay.   Of 151 women with haemodynamic failure and PE only 51 received thrombolysis with a trend towards use either early in pregnancy or in the final 4 weeks. There was a trend towards an increase in the odds of death in patients receiving thrombolysis (age adjusted odds ratio 3.48).       Discussion Whilst the study is limited by the retrospective nature of the data and the fact it is based on administrative data it does identify the continuing high mortality risk of PE in pregnancy. Once haemodynamic deterioration sets in, thrombolysis is only partially effective as evidenced by the high in-hospital mortality in the thrombolysis group of 43%.   Given the lack of data at a patient level available to the authors it is not possible to suggest thrombolysis is under or overused or that it is clearly associated with worse outcomes only that it requires more research.   More work is needed in identification and prevention for PE before haemodynamic failure occurs.   

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Pregnancy Outcomes in Women After Arterial Switch Operation for Transposition of the Great Arteries: Results From ROPAC (Registry of Pregnancy and Cardiac Disease) of the European Society of Cardiology EURObservational Research Programme

Pregnancy Outcomes in Women After Arterial Switch Operation for Transposition of the Great Arteries: Results From ROPAC (Registry of Pregnancy and Cardiac Disease) of the European Society of Cardiology EURObservational Research Programme Tutarel O, Ramlakhan KP, Baris...

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Method comparison of HPLC-ninhydrin-photometry and UHPLC-PITC-tandem mass spectrometry for serum amino acid analyses in patients with complex congenital heart disease and controls

Method comparison of HPLC-ninhydrin-photometry and UHPLC-PITC-tandem mass spectrometry for serum amino acid analyses in patients with complex congenital heart disease and controls Michel M, Salvador C, Wiedemair V, Adam MG, Laser KT, Dubowy KO, Entenmann A, Karall D,...

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