1/19. High-risk pregnancy in beta-thalassemia major women. Report of three cases.Reproductive failure is common in beta-thalassemia major patients because of endocrine damage resulting from iron overload. Here 3 full-term pregnancies following spontaneous ovulation in 2 splenectomized beta-thalassemia major women are reported. The main echocardiographic parameters, such as left ventricular end-diastolic and end-systolic diameters, fractional shortening and ejection fraction, were within the normal range before pregnancy, but worsened during gestation, and 1 patient developed pre-congestive heart failure. deferoxamine therapy was continued throughout 2 pregnancies, while in the other it was stopped after 8 weeks: no abnormalities were noted in the children. Thanks to the currently applied therapies, an increased number of pregnancies may now be expected in beta-thalassemia major women: it is important to find out more about the pregnancy-related problems and their management in these patients.- - - - - - - - - - ranking = 1keywords = heart (Clic here for more details about this article) |
2/19. Patient-controlled analgesia using remifentanil in the parturient with thrombocytopaenia.Patient-controlled intravenous remifentanil was used to provide analgesia in labour for three thrombocytopaenic women. The most successful regimen comprised a patient-demand bolus of 0.5 microg x kg(-1) with a lockout period of 2-3 min, allowing for a successful demand with each contraction. There was an initial period during which the patient learned to anticipate the next contraction and to deliver a bolus about 30 s beforehand; subsequently the remifentanil provided excellent analgesia, with a range of consumption of 426-1050 microg x h(-1). Apart from one episode of maternal sedation and fetal heart rate decelerations resulting from an excessive demand bolus, mothers and neonates tolerated the remifentanil without sequelae. Owing to rapid metabolism by tissue esterase, the use of remifentanil allows adequate doses of opioid to be administered to the mother to achieve good analgesia, without its accumulation in the fetus.- - - - - - - - - - ranking = 1keywords = heart (Clic here for more details about this article) |
3/19. A complication in anticoagulation using low-molecular weight heparin in a patient with a mechanical valve prosthesis. A case report.All mechanical heart valves are thrombogenic, and are associated with thromboembolic complications becomes ineffective. when anticoagulation Controversy exists with regard to the appropriate and safe anticoagulation regimen of gravid women with mechanical heart valve prostheses. While oral anticoagulants such as warfarin may be associated with fetal complications, the role of low-molecular weight heparin (LMWH) and heparinoids (and their respective appropriate dosage) have still to be determined. In developing countries such as saudi arabia, the prevalence of rheumatic fever is high, as is the percentage of female patients with mechanical heart valves and who are of child-bearing age. Thus, the issue of adequate anticoagulation on one hand, and avoidance of warfarin-induced embryopathy on the other hand, is crucial. To date, few reports are available of LMWH as sole anticoagulant in patients with mechanical heart valves. We report a case of massive valve thrombosis with subsequent pulmonary edema after warfarin anticoagulation was changed to LMWH during pregnancy, and administered at too low a dose.- - - - - - - - - - ranking = 1025.360162389keywords = heart valve, valve, heart (Clic here for more details about this article) |
4/19. Mechanical valve thrombosis during pregnancy.Mechanical valve thrombosis is a life-threatening event, and prevention with meticulous anticoagulation is crucial. pregnancy is associated with a hypercoagulable state that further emphasizes the importance of adequate anticoagulation. A case of mechanical mitral valve thrombosis in a pregnant woman due to suboptimal anticoagulation is presented. methods of anticoagulation, as well as thrombolytic and surgical therapies, are discussed.- - - - - - - - - - ranking = 8.7569881334757keywords = valve (Clic here for more details about this article) |
5/19. Anticoagulation for prosthetic heart valves during pregnancy: is low-molecular-weight heparin an alternative?We report on the treatment failure of low molecular weight heparin (LMWH) for anticoagulation in a pregnant woman that underwent artificial mitral valve replacement 10 years prior to her pregnancy. Until she became pregnant warfarin was administered for anticoagulation, but due to the often mentioned increased risk for warfarin-induced maternal and fetal complications, at gestational week 5 the anticoagulation regimen was switched to subcutaneous application of low molecular weight heparin. At gestational week 24 our patient developed acute life-threatening pulmonary edema and hemodynamic instability due to acute mitral valve thrombosis and underwent emergency valve re-replacement with a biological porcine valve. She recovered uneventfully and gave birth to a healthy child at gestational week 35. In addition to our case presentation we review the sparse evidence in the literature regarding anticoagulation in pregnant women with mechanical heart valves and discuss the rational of different anticoagulation regimens with regards to maternal and fetal outcome. Special consideration is directed towards LMWH administration as an alternative to oral anticoagulation during pregnancy in women with mechanical heart valves.- - - - - - - - - - ranking = 1532.9320005056keywords = heart valve, valve, heart (Clic here for more details about this article) |
6/19. warfarin-associated fetal intracranial hemorrhage: a case report.A 27-yr-old woman who had been taking warfarin for 10 yr after mitral valve replacement became pregnant. After knowing her pregnancy, she received heparinization for nine weeks instead of warfarin, and took oral anticoagulant again. At 24 weeks of gestation, fetal ultrasound and MRI showed a left subdural hematoma, and the pregnancy was terminated. Subdural hematoma was demonstrated on autopsy. Fatal bleeding of the fetus is a rare complication of maternal warfarin medication, occurring mostly in the second or third trimester. There is no alternative regimen available, so that regular monitoring by fetal ultrasound and strict control of warfarin dose with regular measurement of prothrombin time are the best way to prevent intrauterine fetal death due to bleeding.- - - - - - - - - - ranking = 1.459498022246keywords = valve (Clic here for more details about this article) |
7/19. Rapid death from thrombotic thrombocytopaenic purpura following caesarean section.We report a case of rapid death from thrombotic thrombocytopaenic purpura (TTP) in a young pregnant lady who developed full blown symptoms soon after caesarean section. Extensive intramyocardial confluent haemorrhages and widespread microthrombi in heart, brain, adrenals and kidney were found at autopsy. Thrombotic thrombocytopaenic purpura is an uncommon condition, which carries a high fatality rate if untreated. awareness of this syndrome together with its high risk of sudden death underlines the importance of rapid diagnosis and treatment.- - - - - - - - - - ranking = 1keywords = heart (Clic here for more details about this article) |
8/19. Juvenile-onset hypergammaglobulinemic purpura and fetal congenital heart block.Waldenstrom's hypergammaglobulinemic purpura (HGP) is a rare chronic disorder characterized by recurrent purpura on the legs, a polyclonal increase in serum gamma-globulin, an elevated erythrocyte sedimentation rate and a positive rheumatoid factor. A 30-year-old primigravid woman with 14 years of HGP was found to have fetal bradycardia at 25 weeks' gestation. Laboratory investigations demonstrated positive anti-Ro/SSA and anti-La/SSB antibodies in the maternal serum. Cesarean delivery was performed at 39 weeks, and a 2750-g female infant was born with complete atrioventricular block. Fortunately, the neonatal period has been uneventful without need for pace-making. Maternal HGP exacerbated just after delivery, but resolved within 1 week without treatment. physicians should be aware of the possible presence of neonatal lupus-related anti-Ro/SSA and anti-La/SSB autoantibodies in patients with HGP. Screening for these autoantibodies is important and could be used as a marker to identify and manage high-risk pregnancies.- - - - - - - - - - ranking = 4keywords = heart (Clic here for more details about this article) |
9/19. Familial IgG subclass imbalance, anti-SS-A antibodies and third-trimester foetal death.Foetal heart block occurred in the second pregnancy of an apparently healthy 23-yr-old woman. Her mother and sister were known for 10 yr with hypergammaglobulinaemia which was due to a disproportionate polyclonal elevation of serum IgG1 and with a high titre of rheumatoid factors. No associated disease was obvious. A third-trimester foetal death had occurred with each of these patients. In the sera of these three women circulating anti-SS-A (Ro) antibodies were detected, which are known to be associated with congenital heart block. IgG subclass imbalance, consisting of a disproportionate polyclonal elevation of IgG1, has been recognised as being associated with a characteristic autoantibody pattern. Familial occurrence of this syndrome as such has hitherto not been reported.- - - - - - - - - - ranking = 2keywords = heart (Clic here for more details about this article) |
10/19. Percutaneous balloon mitral valvuloplasty in a pregnant woman with mitral stenosis, sickle cell crisis and acute pulmonary edema. A case report.A woman with acute congestive heart failure secondary to mitral stenosis and sickle cell crisis was treated successfully with a combination of an exchange transfusion and percutaneous balloon valvuloplasty. That combination provided an alternative to surgical mitral commissurotomy, with its significant risks for both the mother and fetus. The patient was able to undergo an uncomplicated pregnancy course despite the increased risk of cardiac decompensation in the intrapartum and postpartum period.- - - - - - - - - - ranking = 1keywords = heart (Clic here for more details about this article) |
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