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Query: UMLS:C0018799 (heart disease)
 34,133 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

The most important advancement in perinatology during the past few years has been the possibility to selectively establish a criterion to judge high risk pregnancies, which still represent the great majority of cases of materno-infant morbimortality. Social, economic, and cultural factors, age, biological antecedents of the mother, previous pregnancies, and medical history, have all a great influence in the evaluation of gestation. Through the years several models have been constructed to evaluate high perinatal risks; excluding complications due to danger of congenital abnormalities only 19% of women are exposed to high risk pregnancy. Among prenatal risk factors the most common are toxemia, chronic hypertension, severe cardiopathy, and diabetes; risk factors that may become more evident during delivery or shortly before it are toxemia again, premature rupture of membranes, meconial amniotic fluid, and abnormal presentation.
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PMID:[Perinatal medicine. Medico-social implications. I. Technics used in the identification of high risk pregnancy]. 45 11

Fetal echocardiographic examination was performed on 945 pregnant women (normal pregnancy: 291, high risk pregnancy: 654) since 1980. Of these, 39 fetuses (4.1%) were diagnosed as having cardiac arrhythmia. Fifteen fetuses had bradycardia, 7 tachycardia and 17 had an ectopic beat. These had been followed from 1 day to 8 years (mean 1 year and 6 months) soon after birth. Of the 15 cases with bradycardia (complete AV block; 8, 2:1 AV block; 3 and sinus bradycardia; 4), four resulted in an intrauterine fetal death, one was terminated and 5 died soon after birth. The remaining 5 cases are alive and 3 of these 5 have received an implanted pacemaker. Of these 15 cases with bradycardia 7 were associated with congenital heart disease, 6 of which died. Seven cases had tachycardia (supraventricular tachycardia: 3 and atrial flutter with 2:1 AV block: 3). Transplacental antiarrhythmic drug (digoxin and/or verapamil) administration was instituted in 5 cases and a conversion of the arrhythmia was achieved in 4. Paroxysmal tachycardia still remained after delivery in the other 3 cases. Two cases with supraventricular tachycardia (one of them with WPW syndrome type B) were resolved. One case has had persistent chaotic atrial rhythm for 7 years after birth. Of the 17 with an ectopic beat, 11 cases were diagnosed to have a supraventricular ectopic beat and 6 cases with a ventricular ectopic beat. A remaining arrhythmia was observed in 10 cases after delivery but all of these were resolved within 3 months after birth. Fetal tachycardia had relatively favorable prognosis because usually the intrauterine treatment was effective. However, fetal bradycardia had poor prognosis and further investigations to establish more effective treatments are essential.
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PMID:Fetal arrhythmias; intrauterine diagnosis and treatment. 184 Nov 76

For women whose health cannot support pregnancy, the author's obstetrics department has formed a multidisciplinary team to counsel couples on psychological and practical aspects of contraception and abortion. High risk pregnancies are those occuring in women with such disorders as cardiopathy, nephropathy, hypertension, diabetes, cancer, Rhesus isoimmunization and psychosis. Two approaches are used: to prevent or terminate pregnancy. Contraception must be explained concretely, addressing the couples' particular situation and personality. Pills are often contraindicated, in high risk patients as are IUDs in nulliparas and those taking anticoagulants. Many couples used to careful medical surveillance can adjust to temperature rhythm or diaphragms. For women who must have Tubal ligation, the decision is made jointly by the couple, obstetrician, psychotherapist and specialist. Counseling is usually necessary to prevent psychological or sexual dysfunction, particularly in those sterilized during caesarean section if the infant's survival is also at risk. A similar multidisciplinary team is consulted for therapeutic abortion alone or combined with tubal ligation.
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PMID:[Fecundity and high risk pregnancy]. 507 55

The diagnosis of congenital heart disease by means of echocardiography is already a real fact. The use of this technique for diagnosis in utero currently allows the detection of these malformations during the early stages of pregnancy and to determine the prognosis of the fetal cardiopathies, as well as to establish a medical or surgical treatment of the neonate. The prenatal echocardiographic study of 126 pregnant women, previously having had children with heart disease, has allowed s to prove the greater incidence of cardiopathy in this population (6.4%), compared to the results obtained from a group of pregnant women previously having normal children and without a high risk pregnancy (0.8%). These findings support the theory that genetic factors are the primary cause of congenital cardiac malformations, although the existence of teratogen factors (rubella, diabetes, etc.) in some cases cannot be excluded.
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PMID:[Congenital familial cardiopathies. Prenatal diagnosis]. 846 Aug 38

Patients with congenital cardiac disease require lifelong medical care. Current challenges that face practitioners who care for adults with congenital heart disease include identifying the best location for procedures, which could be a children's hospital, an adult hospital, or a tertiary care facility; providing appropriate antenatal management of pregnant women with congenitally malformed hearts, and continuing this care in the peripartum period; and securing the infrastructure and expertise of the non-cardiac subspecialties, such as nephrology, hepatology, pulmonary medicine, and haematology. The objectives of this review are to outline the common problems that confront this population of patients and the medical community, to identify challenges encountered in establishing a programme for care of adults with congenitally malformed hearts, and to review the spectrum of disease and operations that have been identified in a high volume tertiary care centre for adult patients with congenital cardiac disease. Three chosen examples of the fundamental problems facing the practitioner and patient in the United States of America in 2007 are the neglected patient with congenital cardiac disease, weak infrastructure for adults with congenital cardiac disease, and family planning and management of pregnancy for patients with congenital cardiac disease. Patients with adult congenital cardiac disease often do not receive appropriate surveillance. Three fundamental reasons for this problem are, first, that most adults with congenitally malformed hearts have been lost to follow-up by specialists, and are either receiving community care or no care at all. Second, patients and their families have not been educated about their malformed hearts, what to expect, and how to protect their interests most effectively. Third, adult physicians have not been educated about the complexity of the adult with a congenitally malformed heart. This combination can be fatal for adults with complications related to their congenitally malformed heart, or its prior treatment. Two solutions would improve surveillance and care for the next generation of patients coming out of the care of paediatric cardiologists. The first would be to educate patients and their families during childhood and adolescence. They would learn the names of the diagnoses and treatments, the problems they need to anticipate and avoid, the importance of expert surveillance, career and family planning information, and appropriate self-management. The second solution would be to encourage an orderly transfer of patients from paediatric to adult practice, usually at about 18 years of age, and at the time of graduation from high school. Clinics for adults with congenital cardiac disease depend upon multidisciplinary collaboration with specialties in areas such as congenital cardiac imaging, diagnostic and interventional catheterization, congenital cardiac surgery and anaesthesia, heart failure, transplantation, electrophysiology, reproductive and high risk pregnancy services, genetics, pulmonary hypertension, hepatology, nephrology, haematology, and others. None of these services are easily available "off the rack", although with time, experience, and determination, these services can develop very well. Facilities with experienced personnel to provide competent care for adults with congenital cardiac disease are becoming increasingly available. Parents and patients should learn that these facilities exist, and be directed to one by their paediatric caregivers when the time comes for transition to adult care. With the steady increase in the number of adults with congenital heart disease, an ever increasing number of women with such disease are becoming pregnant. Services are not widely available to assess competently and plan a pregnancy for those with more complex disease. It is essential to have a close interplay between the obstetrician, the adult congenital cardiologist, the fetal medicine perinatologist, and neonatologist. In both a community based programme and a tertiary care centre, the nuances and complexities of congenital cardiac anatomy, coupled with the high probability of previous operation during childhood, makes the trained congenital cardiothoracic surgeon best suited to deal with the surgical needs of this growing population. It is clear that the majority of adults with congenital heart disease are not "cured", but require lifelong comprehensive care from specialists who have expertise in this complex arena. There is a growing cadre of healthcare professionals dedicated to improving the care of these patients. More information has become available about their care, and will be improved upon in the next decade. With the support of the general paediatric and paediatric cardiologic communities, and of the Adult Congenital Heart Association, and with the persistence of the providers of care for adults with congenital cardiac disease currently staffing clinics, the care of these patients should become more secure in the next decade as we mature our capabilities.
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PMID:Caring for adults with congenital cardiac disease: successes and challenges for 2007 and beyond. 1803 2

Adult Congenital Heart Disease (ACHD) complicating pregnancy remains a relatively new and evolving field. An acceptance by paediatric cardiologists of the importance of working alongside their colleagues dealing with adult care as their patients get older is vital to ensure that these patients are provided with seamless continuity of care. One might have expected that as ACHD cardiologists increasingly forge ties with obstetricians who manage high risk pregnancy so that together they provide care for their mutual patients, we would see the mortality and morbidity of pregnancy in women with heart disease decline. Sadly this is yet to be the case and cardiac disease remains the leading single indirect cause of maternal death in the developed world. These disappointing figures should act as wake up call not only to the profession but also to those involved in commissioning and funding such services. Some progress has been made improving the outlook for many women with complex congenital heart disease as they consider embarking upon pregnancy. However, concerns still exist in relation to young patients being lost to follow-up and presenting pregnant without appropriate counselling and optimization of their cardiac condition. Furthermore it is unclear whether there is currently adequate workforce planning to deliver enough trained specialists who have the expertise to work in this area in the future. We submit herewith that further investment is essential if we wish to see improvements in the care of women with heart disease in relation to pregnancy.
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PMID:A time for greater investment into care for pregnancy and heart disease. 2742 83