| 1. |
- Campens, Laurence, et al.
(författare)
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Pregnancy outcome in thoracic aortic disease data from the Registry of Pregnancy and Cardiac disease
- 2021
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Ingår i: Heart. - 1355-6037 .- 1468-201X. ; 107, s. 1704-1709
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Tidskriftsartikel (refereegranskat)abstract
- Background Cardiovascular disease is the leading cause of death during pregnancy with thoracic aortic dissection being one of the main causes. Thoracic aortic disease is commonly related to hereditary disorders and congenital heart malformations such as bicuspid aortic valve (BAV). Pregnancy is considered a high risk period in women with underlying aortopathy. Methods The ESC EORP Registry Of Pregnancy And Cardiac disease (ROPAC) is a prospective global registry that enrolled 5739 women with pre-existing cardiac disease. With this analysis, we aim to study the maternal and fetal outcome of pregnancy in women with thoracic aortic disease. Results Thoracic aortic disease was reported in 189 women (3.3%). Half of them were patients with Marfan syndrome (MFS), 26% had a BAV, 8% Turner syndrome, 2% vascular Ehlers-Danlos syndrome and 11% had no underlying genetic defect or associated congenital heart defect. Aortic dilatation was reported in 58% of patients and 6% had a history of aortic dissection. Four patients, of whom three were patients with MFS, had an acute aortic dissection (three type A and one type B aortic dissection) without maternal or fetal mortality. No complications occurred in women with a history of aortic dissection. There was no significant difference in median fetal birth weight if treated with a beta-blocker or not (2960 g (2358-3390 g) vs 3270 g (2750-3570 g), p value 0.25). Conclusion This ancillary analysis provides the largest prospective data review on pregnancy risk for patients with thoracic aortic disease. Overall pregnancy outcomes in women with thoracic aortic disease followed according to current guidelines are good.
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| 2. |
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| 3. |
- Eriksson, Peter J, 1959, et al.
(författare)
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Transcatheter Intervention for Coarctation of the Aorta A Nordic Population-Based Registry With Long-Term Follow-Up
- 2023
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Ingår i: Jacc-Cardiovascular Interventions. - : Elsevier BV. - 1936-8798 .- 1876-7605. ; 16:4, s. 444-453
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND Coarctation of the aorta (CoA), a congenital narrowing of the proximal descending thoracic aorta, is a relatively common form of congenital heart disease. Untreated significant CoA has a major impact on morbidity and mortality. In the past 3 decades, transcatheter intervention (TCI) for CoA has evolved as an alternative to surgery.OBJECTIVES The authors report on all TCIs for CoA performed from 2000 to 2016 in 4 countries covering 25 million inhabitants, with a mean follow-up duration of 6.9 years.METHODS During the study period, 683 interventions were performed on 542 patients.RESULTS The procedural success rate was 88%, with 9% considered partly successful. Complications at the intervention site occurred in 3.5% of interventions and at the access site in 3.5%. There was no in-hospital mortality. During follow-up, TCI for CoA reduced the presence of hypertension significantly from 73% to 34%, but despite this, many patients remained hypertensive and in need of continuous antihypertensive treatment. Moreover, 8% to 9% of patients needed aortic and/or aortic valve surgery during follow-up.CONCLUSIONS TCI for CoA can be performed with a low risk for complications. Lifetime follow-up after TCI for CoA seems warranted. (J Am Coll Cardiol Intv 2023;16:444-453) & COPY; 2023 by the American College of Cardiology Foundation.
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| 4. |
- Fazlinovic, Sanin, et al.
(författare)
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Outcome and survival after open heart surgery for adults with congenital heart disease - a single center experience
- 2021
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Ingår i: Scandinavian Cardiovascular Journal. - : Informa UK Limited. - 1401-7431 .- 1651-2006. ; 55:6, s. 345-353
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Tidskriftsartikel (refereegranskat)abstract
- Introduction. Congenital heart disease (CHD) is the most common type of birth defect today. The adult congenital heart disease (ACHD) population is constantly growing and becoming older and more patients require cardiac surgery. The objective of this study was to review the surgical outcome of the open heart procedures performed on ACHD patients in the last 10 years at Sahlgrenska University Hospital (SUH) through a retrospective descriptive cohort study. Methods. A retrospective data collection was performed for 421 patients who underwent a total of 439 surgical procedures between 2009 and 2018 at the Cardiothoracic department in SUH. The primary outcomes were early (<30 days) and late survival. Secondary outcomes were postoperative complications and independent risk factors for postoperative complications. Results. 30-day mortality was 1.9%. Long-term survival after 3, 5 and 10 years were 96% +/- 1, 94.3% +/- 1.3 and 92.4% +/- 1.8. 82 major complications occurred after 46 procedures (11.6%). The most common major complication was re-exploration due to hemorrhage. Risk factors for major complications were acute surgery and prolonged extracorporeal circulation time. 173 minor complications occurred after 90 procedures (22.5%). The most common minor complication was prolonged intensive care unit stay (>48 h). Conclusion. This study presents satisfactory early and midterm survival. The survival and frequency of major postoperative complications are well in line with what other studies have presented. Patients undergoing resternotomies had no increased risk for mortality or postoperative complications.
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| 5. |
- Furenäs, Eva, et al.
(författare)
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Cardiac Complications during Pregnancy Related to Parity in Women with Congenital Heart Disease
- 2020
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Ingår i: Cardiology. - : S. Karger AG. - 0008-6312 .- 1421-9751. ; 145:8, s. 533-541
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Tidskriftsartikel (refereegranskat)abstract
- Objective:To describe the frequency of cardiac complications during pregnancy related to parity in women with congenital heart defects.Methods:A retrospective tertiary single-center study at the Adult Congenital Heart Disease Centre that followed 307 women with congenital heart disease during the years 1997-2015 in Gothenburg, Sweden. Ma-ternal cardiac complications were noted for each pregnancy using medical and obstetric records. The CARPREG I and modified WHO (mWHO) risk classifications were used. Twin pregnancies, miscarriages before gestational week 13, and pregnancy terminations were excluded.Results:Five hundred seventy-one deliveries and 9 late miscarriages were analyzed. The mean parity was 1.74 per woman (range 1-8). Eighty-four (14.6%) maternal cardiac complications were experienced; arrhythmia (5.7%) and heart failure (4.4%) being the most prevalent, and there was 1 maternal death. Heart failure occurred during the first pregnancy in 12 women (3.9%), in the second pregnancy in 8 women (4.3%), and in the third pregnancy in 4 women (7.7%). CARPREG I and mWHO scores were associated with an increased risk of having a cardiac complication, while parity per se was not associated. The OR for having a maternally uneventful second pregnancy if the first pregnancy was without cardiac complications was 5.47 (95% CI 1.76-16.94) after controlling for CARPREG I and mWHO scores.Conclusion:The risk of severe maternal cardiac complications during pregnancy in women with congenital heart disease is low. In this largest analysis to date with a focus on parity in 307 women, the risk classification predicts the maternal outcome more than parity per se. If the first pregnancy is uneventful, the OR is 5.5 for an uneventful second pregnancy if CARPREG I and mWHO scores remain unchanged.
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| 6. |
- Furenäs, Eva, et al.
(författare)
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Effect of maternal age and cardiac disease severity on outcome of pregnancy in women with congenital heart disease
- 2017
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Ingår i: International Journal of Cardiology. - : Elsevier BV. - 0167-5273. ; 243, s. 197-203
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Tidskriftsartikel (refereegranskat)abstract
- Background: There is an increasing prevalence of women with congenital heart defects reaching childbearing age. In western countries women tend to give birth at a higher age compared to some decades ago. We evaluated the CARdiac disease in PREGnancy (CARPREG) and modified World Health Organization (mWHO) risk classifications for cardiac complications during pregnancies in women with congenital heart defects and analyzed the impact of age on risk of obstetric and fetal outcome. Methods: A single-center observational study of cardiac, obstetric, and neonatal complications with data from cardiac and obstetric records of pregnancies in women with congenital heart disease. Outcomes of 496 pregnancies in 232 women, including induced abortion, miscarriage, stillbirth, and live birth were analyzed regarding complications, maternal age, mode of delivery, and two risk classifications: CARPREG and mWHO. Results: There were 28 induced abortions, 59 fetal loss, 409 deliveries with 412 neonates. Cardiac (14%), obstetric (14%), and neonatal (15%) complications were noted, including one maternal death and five stillbirths. The rate of cesarean section was 19%. Age above 35 years was of borderline importance for cardiac complications (p = 0.054) and was not a significant additional risk factor for obstetric or neonatal complications. Both risk classifications had moderate clinical utility, with area under the curve (AUC) 0.71 for CARPREG and 0.65 for mWHO on cardiac complications. Conclusions: Pregnancy complications in women with congenital heart disease are common but severe complications are rare. Advanced maternal age does not seem to affect complication rate. Existing risk classification systems are insufficient in predicting complications. (C) 2017 Elsevier B.V. All rights reserved.
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| 7. |
- Furenäs, Eva, et al.
(författare)
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Pregnancy in a healthy population: dynamics of NTproBNP and hs-cTroponin T
- 2020
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Ingår i: Open Heart. - : BMJ. - 2053-3624. ; 7:2
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Tidskriftsartikel (refereegranskat)abstract
- Objective To describe the intraindividual changes of heart biomarker levels during and after pregnancy and to evaluate existing cut-off levels for heart failure or myocardial ischaemia in pregnant women. Method A total of 196 healthy pregnant women were recruited from maternal outpatient clinics and included in the study. Blood samples were obtained on four occasions: at 10-12 gestational weeks (gw), 20-25 gw, after delivery and 6 months postpartum and analysed for N-terminal pro-brain natriuretic peptide (NTproBNP) and high sensitive cardiac troponin T (hs-cTNT). Echocardiography ruled out existing cardiac disease. Estimated glomerular filtration rate (eGFR) was calculated. Results There were significant changes in NTproBNP between the measurements with the highest NTproBNP at 10-12 gw and the lowest value being at 20-25 gw, (with eGFR being the highest). Hs-cTNT was significantly higher at the peripartum measurement compared with the other measurements (p<0.05). Regardless, the 95th percentile for both biomarkers was below cut-off levels of 300 ng/L for NTproBNP and 14 ng/L for hs-cTNT. There was an association between NTproBNP above the upper limit of normal of 125 ng/L and eGFR (p=0.04) and between hs-cTNT >5.0 ng/L and time from delivery to blood sample (p=0.001) at the peripartum measurement. Both were associated with the use of oxytocin. Conclusion Existing cut-off values for ruling out heart failure (NTproBNP <300 ng/L) and myocardial ischaemia (hs-cTNT <14 ng/L) are applicable during pregnancy and after delivery. Elevated levels mandate further attention on cardiac symptoms and renal function.
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| 8. |
- Furenäs, Eva
(författare)
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Pregnancy in women with congenital heart disease
- 2021
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Abstract Background: The survival for children born with congenital heart disease (CHD) has increased and the majority reach adult age. Having a cardiac problem raise questions on the probability of successful pregnancies and predictors associated with unfavorable outcome. Heart biomarkers are used in emergency care to evaluate patients with chest symptoms. However, normal levels during pregnancy have not been established. Aims: The aims of the thesis were to study risk of cardiac, obstetric and neonatal outcome of pregnancy in women with CHD, and evaluate two risk-classifications. To obtain additional diagnostic tools when evaluating pregnant women with chest symptoms. Methods: The participants in Paper I and II were single CHD-center cohorts of 232 and 307 women respectively, with 496 and 580 pregnancies respectively. The women were classified according to two prevalent risk classifications (CARPREG and mWHO). In Paper I we evaluated maternal age and the applicability of risk classifications on cardiac, obstetric and neonatal outcomes of pregnancy. Paper II addressed parity as a covariate for cardiac events. In Paper III national registries, National Patient Register, Medical Birth Register and Cause of Death register were used. Women with CHD born 1953-1997 with first singleton birth 1973-2015 were compared with matched controls without a diagnosis of CHD. Outcomes were cardiac, obstetric and neonatal complications. In Paper IV 196 pre-pregnancy healthy women were recruited from antenatal maternal outpatient clinics. Blood samples were analyzed for heart biomarkers N-terminal pro Brain Natriuretic Peptide (NTproBNP) and high sensitive cardiac Troponin T (hs-cTNT) on four occasions during and after pregnancy. Results: In Paper I in 496 CHD pregnancies, there were 14% cardiac complications, 14 % obstetric and 15% neonatal complications, comparable with previous single- and multicenter publications. Severe complications were rare. Age above 35 years was not associated with worse outcome. The two risk classifications had moderate diagnostic accuracy of 0.71 and 0.65 respectively. In Paper II we analyzed the effect of parity in 307 CHD women. We found a high odds ratio of 5.5 (95% CI, 1.8-16.9) to have the same cardiac outcome of a second pregnancy as the first, if the risk classification remained the same. In paper III both cardiac, obstetric and neonatal adverse events were more common in 6´131 CHD women than in 158´343 controls, but with low absolute numbers. Severe complications were very rare. Maternal all-cause mortality during pregnancy and one year postpartum was 3/10´000. Perinatal death was 55/10´000 to be compared with 38/10´000 in controls. During the observation time-period the number and complexity of CHD diagnoses increased, as did age at first birth and maternal weight. In Paper IV we established the 95th percentile levels of NTproBNP and hs-cTNT for pre-pregnancy healthy women to be below the cut-off levels for the suspicion of heart failure and myocardial ischemia. Existing cut-off levels can be used also in pregnant women in the emergency room. Conclusion: Two established risk classifications had moderate diagnostic accuracy. The maternal outcome of a second pregnancy can be expected to be the same as of the first, if in stable cardiac situation. The absolute risks for adverse outcome of pregnancy in women with CHD are low, but higher than in controls. Existing cut-off levels of heart biomarkers can be used also during pregnancy, in pre-pregnancy healthy women. Keywords: congenital heart disease, pregnancy, risk classification, parity, heart biomarker.
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| 9. |
- Furenäs, Eva, et al.
(författare)
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Troponins and Pregnancy.
- 2023
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Ingår i: JAMA cardiology. - 2380-6591. ; 8:9
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Tidskriftsartikel (övrigt vetenskapligt/konstnärligt)
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| 10. |
- Jensen, A. S., et al.
(författare)
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Cause-Specific Mortality in Patients During Long-Term Follow-Up After Atrial Switch for Transposition of the Great Arteries
- 2022
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Ingår i: Journal of the American Heart Association. - : Ovid Technologies (Wolters Kluwer Health). - 2047-9980. ; 11:14
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Tidskriftsartikel (refereegranskat)abstract
- Background Little is known about the cause of death (CoD) in patients with transposition of the great arteries palliated with a Mustard or Senning procedure. The aim was to describe the CoD for patients with the Mustard and Senning procedure during short- (<10 years), mid- (10-20 years), and long-term (>20 years) follow-up after the operation. Methods and Results This is a retrospective, descriptive multicenter cohort study including all Nordic patients (Denmark, Finland, Norway, and Sweden) who underwent a Mustard or Senning procedure between 1967 and 2003. Patients who died within 30 days after the index operation were excluded. Among 968 patients with Mustard/Senning palliated transposition of the great arteries, 814 patients were eligible for the study, with a mean follow-up of 33.6 years. The estimated risk of all-cause mortality reached 36.0% after 43 years of follow-up, and the risk of death was highest among male patients as compared with female patients (P=0.004). The most common CoD was sudden cardiac death (SCD), followed by heart failure/heart transplantation accounting for 29% and 27%, respectively. During short-, mid-, and long-term follow-up, there was a change in CoD with SCD accounting for 23.7%, 46.6%, and 19.0% (P=0.002) and heart failure/heart transplantation 18.6%, 22.4%, and 46.6% (P=0.0005), respectively. Conclusions Among patients corrected with Mustard or Senning transposition of the great arteries, the most common CoD is SCD followed by heart failure/heart transplantation. The CoD changes as the patients age, with SCD as the most common cause in adolescence and heart failure as the dominant cause in adulthood. Furthermore, the risk of all-cause mortality, SCD, and death attributable to heart failure or heart transplantation was increased in men >10 years after the Mustard/Senning operation.
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