Daniel Born

Pregnancy in patients with prosthetic heart valves: the effects of anticoagulation on mother, fetus, and neonate.

Maternal and fetal complications in a consecutive series of 60 pregnancies in 49 patients with prosthetic heart valves were prospectively evaluated. Group 1 consisted of 40 pregnancies in 31 patients who were taking oral anticoagulants. No oral anticoagulation was used in 20 pregnancies in 19 patients (group 2). In group 1 there were three instances of acute valvular thrombosis during the 35 pregnancies in patients with mechanical prostheses, with two maternal deaths. There were two episodes of cerebral embolism, one in group 1 and one in group 2. Patients with isolated aortic valve replacement had fewer maternal complications (2 of 13) than patients with isolated mitral valve replacement (15 of 42) without statistical significance. Severe bioprosthesis dysfunction occurred in 4 of 25 pregnancies (one rupture and three stenosis) with two maternal deaths, one in the puerperium and the other in the postoperative period of cardiac surgery during pregnancy. When analyzing obstetric events we observed seven spontaneous abortions and one hydatidiform mole. All spontaneous abortions occurred in group 1. The incidences of prematurity and low birth weight were significantly higher in group 1 than in group 2 (46.6% vs 10.5%, p less than 0.05, and 50% vs 10.5%, p less than 0.05, respectively). Moreover, there was a significant association between prematurity and the mothers New York Heart Association functional class (61.5% in classes III and IV vs 22.2% in classes I and II, p less than 0.05). There were five neonatal deaths, all in group 1 (p = NS vs group 2). Three infants had warfarin-related congenital defects.(ABSTRACT TRUNCATED AT 250 WORDS)

SUCCESSFUL USE OF DEEP HYPOTHERMIC CIRCULATORY ARREST IN PREGNANCY

A woman pregnant for 21 weeks underwent an emergency operation because of an aortic arch aneurysm that had ruptured into her left lung. Cardiopulmonary bypass and deep hypothermia were used and she needed 37 minutes of circulatory arrest at a core temperature of 19 degrees C. Both the mother and fetus survived, and a normal baby was delivered by cesarean section at the 39th week of gestation.

Mortalidade materna por cardiopatia

Realizou-se estudo retrospectivo da mortalidade materna por cardiopatia, no periodo de janeiro de 1979 a dezembro de 1989. Dentre um total de 16.423 internacoes, houve 694 gestantes com o diagnostico de cardiopatia (4,2%). No mesmo periodo, ocorreram 51 obitos maternos, correspondendo a um coeficiente de mortalidade materna de 428,2/100.000 nascidos vivos. Houve 12 obitos maternos por cardiopatia. A analise estatistica permitiu a identificacao de alguns fatores associados a maior risco de morte nas pacientes cardiopatas: primeira gravidez, primiparidade, ausencia de assistencia pre-natal, realizacao de cirurgia cardiaca anterior a gravidez e/ou na gestacao. O maior numero de mortes ocorreu no puerperio. A classificacao funcional (NYHA) nao se constituiu em parâmetro seguro para avaliar o prognostico materno, pois 91,7% dos casos de obito foram incluidos no grupo considerado favoravel (classes I e II) ao iniciar a gestacao.