[Show abstract][Hide abstract] ABSTRACT: The periodontal disease during pregnancy of women with rheumatic valve disease imply infective endocarditis risks and higher rate of preterm birth and low birth weight.
To study the periodontal disease rate of women with rheumatic valve disease during pregnancy.
We studied 140 pregnant women who included 70 patients with rheumatic valve disease and 70 healthy women. The periodontal examination included: 1) periodontal clinical exam regard the follow variables: a) probing depth; b) gingival margin; c) clinical attachment level; d) bleeding on probing; e) plaque index and f) gingival index; and 2) microbiological test was performed in samples serum and gingival crevicular fluid and considered positive controls to Porphyromonas gingivalis, Tannerella forsithia e Aggregobacter actinomycetemcomitans.
Age and parity were similar between groups; as single or combined the mitral valve disease was prevalent among the rheumatic valve lesion in 45 (32.1%) e 20 (28.5%) cases, respectively. Among the periodontal variables gingival margin (p=0.01) and plaque index (p=0.04) were different between groups. The periodontal disease was identified in 20 (14,3%) pregnant women, seven (10%) of them were patients with valve rheumatic disease and the remain 13 (18,6%) were healthy women, its percentual was not different between groups (p=0,147). Microbiological analyses of oral samples showed higher percentual of P. gingivalis in healthy pregnant women (p=0.004).
The clinical and microbiological study during pregnancy showed comparable incidence of periodontal disease between women with rheumatic valve disease and healthy women.
Arquivos brasileiros de cardiologia 04/2011; 96(4):307-11. · 1.32 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Diretrizes em muito contribuem para minimizar os potenciais riscos obstétricos e fetais e melhorar a assistência durante o ciclo gravídico-puerperal. Contudo, há controvérsias a respeito do manuseio da anticoagulação em mulheres portadoras de cardiopatias. A importância deste assunto assenta-se no fato de que o tromboembolismo é considerado uma das principais causas de morte materna em portadoras de cardiopatia, o que torna obrigatório o conhecimento sobre sua prevenção. A estratégia do tratamento antitrombótico é ponderada pelo risco de trombose imposto pela situação clínica materna e pelos efeitos adversos que os anticoagulantes podem causar ao concepto. Neste artigo, serão discutidas a estratificação do risco materno ao tromboembolismo, as propriedades dos anticoagulantes indicados para a sua prevenção e a estratégia terapêutica nos diversos momentos da gestação, parto e puerpério da mulher portadora de cardiopatia.
[Show abstract][Hide abstract] ABSTRACT: The increase of cardiac output during pregnancy is the cause of heart failure in women with severe aortic valvular stenosis. Percutaneous aortic valvuloplasty has been associated with severe complications and short-term valvar restenosis. This case showed that percutaneous aortic valvuloplasty allowed both mother and fetus to survive after childbirth, and that postpartum treatment interruption resulted in maternal death in late postpartum care.
[Show abstract][Hide abstract] ABSTRACT: The effects of local dental anesthesia with lidocaine and epinephrine on cardiovascular parameters of pregnant women with heart valve diseases and their fetuses are not fully understood.
To assess and analyze cardiotocographic, blood pressure and electrocardiographic parameters of pregnant women with rheumatic heart valve disease undergoing local anesthesia with 1.8mL of lidocaine 2% with or without epinephrine 1:100,000 during restorative dental treatment.
Maternal ambulatory blood pressure and electrocardiographic monitoring as well as cardiotocography of 31 patients with rheumatic heart disease were performed between the 28th and 37th week of gestation. The patients were divided into two groups, those with or without vasoconstrictor.
A significant reduction in maternal heart rate was shown in both groups during the procedure in comparison with the other periods (p<0.001). Cardiac arrhythmia was observed in nine (29.0%) patients, of which seven (41.8%) were from the group of 17 pregnant women who received anesthesia plus epinephrine. No difference in maternal blood pressure was observed when periods or groups were compared (p>0.05). The same occurred (p>0.05) with the number of uterine contractions, baseline level and variability, and number of accelerations of fetal heart rate.
The use of 1.8mL of lidocaine 2% in combination with epinephrine was safe and efficient in restorative dental procedures during pregnancy in women with rheumatic heart valve disease.
Arquivos brasileiros de cardiologia 11/2009; 93(5):463-742. · 1.32 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Cardiac surgery improves the maternal prognosis in cases refractory to medical therapy. However, it is associated with risks to the fetus when performed during pregnancy.
To analyze maternal-fetal outcome and prognosis related to cardiac surgery performed during pregnancy and puerperium.
The outcome of 41 gestations of women undergoing cardiac surgery during pregnancy and puerperium was studied. Fetal cardiotocography was performed throughout the procedure in patients with gestational age above 20 weeks.
Mean maternal age was 27.8 +/- 7.6 years; there was a predominance of patients with rheumatic valve disease (87.8%), of whom 15 (41.6%) underwent reoperation due to prosthetic valve dysfunction. Mean extracorporeal circulation time was 87.4+/- 43.6 min and hypothermia was used in 27 (67.5%) cases. Thirteen (31.7%) mothers experienced no events and gave birth to live healthy newborns. Postoperative outcome of the remaining 28 (68.3%) pregnancies showed: 17 (41.5%) maternal complications and three (7.3%) deaths; 12 (29.2%) fetal losses, and four (10%) cases of neurological malformation, two of which progressed to late death. One patient was lost to follow-up after surgery. Nine (21.9%) patients underwent emergency surgery, and this variable was correlated with maternal prognosis (p<0.001)
Cardiac surgery during pregnancy allowed survival of 92.7% of the mothers, and 56.0% of the patients who presented cardiac complications refractory to medical therapy gave birth to healthy children. Worse maternal prognosis was correlated with emergency surgery.
Arquivos brasileiros de cardiologia 07/2009; 93(1):9-14. · 1.32 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: We describe a rare case of permanent pacemaker implantation in a pregnant woman with rheumatic mitral valve disease previously undergoing percutaneous balloon valvuloplasty. She presented symptomatic advanced atrioventricular block of non-reversible cause and manifest in the third trimester of gestation.
[Show abstract][Hide abstract] ABSTRACT: Objective: Presence of any infection site is a risk for a pregnant women with rheumatic valvar disease. The aim of this study was to investigate the clinical periodontal condition of those women and identify the presence of Porphyromonas gingivalis (Pg) from periodontal sulcus/pocket and saliva samples. Methods: A cross sectional study was conducted, 52 pregnant with rheumatic valvar disease (PRVD) and 70 healthy pregnant women (HP), (18 to 35 years old). A complete periodontal examination was performed by a single calibrated (ICC=0.90) blinded examiner who evaluated gingival margin (GM), probing depth (PD), clinical attachment level (CAL), gingival index (GI), plaque index (PI) and bleeding on probing (BOP). Bacterial DNA was extracted from (16 PRVD e 26 HP) periodontal and (14 PRVD e 38 HP) saliva samples. Periodontal bacteria detection was done by PCR. Results: The following mean periodontal parameters were obtained: PI: 12.19 (PRVD)/13.48 (HP) (p= 0,336); GI: 0.41 (PRVD)/0.40 (HP) (p= 0,3526); BOP: 7.34 (PRVD)/6.27 (HP) (p = 0,502); PD: 1.52 (PRVD)/1.45 (HP) (p = 0,124); CAL: 1.13 (PRVD)/1.06 (HP) (p = 0,6119). The prevalence values of Pg were as follow: periodontal samples 33% (PRVD)/37% (HP) and saliva samples 29% (PRVD)/54% (HP). Conclusions: Although there was a tendency for higher values in periodontal clinical parameters evaluated in the patients within the PRVD group, there were no significant statistical differences between the patients with and without RVD. The presence of the Pg in saliva samples of healthy pregnant women is statistically higher than in pregnant woman with valvar disease; however, there was no difference in periodontal samples.
[Show abstract][Hide abstract] ABSTRACT: To study clinical evolution of women with HCM during pregnancy; the influencing factors of gestation on natural course of HCM and the frequency of HCM in their children in early childhood.
A prospective study was conducted in 35 women with HCM; there were 23 pregnant women (PG group) and 12 nonpregnant control patients (NP group), matched for age and functional class (FC). Clinical monthly evaluations were carried out and electrocardiogram and transthoracic echocardiography tests were performed. The offspring endpoints included stillbirth and prematurity rates and investigation of HCM during childhood.
No deaths occurred in either group. Cardiac arrhythmias were significantly (p< 0.05) more frequent in the NP group (33.3% vs. 13.4%), and no differences were observed between the groups (p>0.05) in heart failure (30.3% vs. 16.6%) or ischemic stroke (4.3% vs. 8.3%) rates. In the PG group, required hospitalization for treatment of cardiac complication was more frequent (p=0.05) in patients with family history of HCM (71.4% vs. 25.0%). Cesarean section was performed in 12 (52%) patients, for obstetrical reasons; there were 7 (30.4%) premature babies and 1 (4.3%) neonatal death. One child was clinically diagnosed as having HCM, and his genetic study identified a mutation in the beta myosin heavy chain gene, located on chromosome 14.
Heart failure is a frequent cardiac complication in women with HCM during pregnancy, particularly in patients with family history of the disease, but this did not influence the natural course of HCM. In one child, clinical examination allowed HCM identification during early childhood.
Arquivos brasileiros de cardiologia 05/2007; 88(4):480-5. · 1.32 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Acute aortic dissection is one of the most dreaded clinical conditions during pregnancy. Difficulties in establishing a diagnosis and limitations regarding invasive studies increase mortality rates associated with the disease. The limited experience reported in the literature does not allow the determination of guidelines for clinical and/or surgical management of aortic dissection in pregnancy. The authors present a case of acute aortic dissection in a woman in her 33rd week of gestation and discuss the diagnostic approach considering the peculiarities of the diseases manifestation.
Arquivos brasileiros de cardiologia 11/2006; 87(4):e112-5. · 1.32 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: To study vascular reactivity according to the analysis of blood flow and peripheral vascular resistance at rest and during mental stress in pregnant women with mitral stenosis.
Twenty two women with mitral stenosis, 13 of whom were pregnant (PS) and 9 were non-pregnant (MIS), and 9 healthy pregnant women (NP) were studied. During gestation, 9 out of the 13 patients of the PS group required a beta-blocker (PSB) and the remaining 4 progressed without medication (PSWB). Plethysmography at rest and during mental stress analyzed muscle blood flow, peripheral vascular resistance (PVR), mean arterial pressure (MAP) and heart rate (HR) during gestation and puerperium.
During gestation of PSWB, muscle blood flow and HR were higher in 1.6% and 20.5% (p = 0.05), and PVR and MAP were lower in 19.3% and 4.4%, respectively, in comparison to the puerperium; during mental stress, the muscle blood flow increased by 55.9%, HR decreased by 30.2% and PVR and MAP were similar. In PSB, muscle blood muscle blood flow and HR were greater in 5.9% and 14.9% (p= 0.001) and MAP and PVR were lower in 10.3% and 9.1%, respectively, when compared to the puerperium. During mental stress, muscle blood flow and MAP increased by 69.8% and 174.1%, respectively. HR was similar and PVR decreased by 53.7%. The comparative study showed that in the NP group the muscle blood flow was higher, PVR was lower, and MAP and HR were similar in relation to the PS group, and that the PS, NP, MIS groups had a similar response to mental stress.
Vascular reactivity in pregnant women with mitral stenosis was preserved and the analysis of measurements showed lower values of muscle blood flow and higher values of PVR when compared to those of healthy pregnant women.
Arquivos Brasileiros de Cardiologia 09/2006; 87(2):128-36. · 1.13 Impact Factor