The aim of this retrospective study was to compare the different anticoagulation regimens used in pregnant women with prosthetic heart valves. We reviewed 196 pregnancies in 110 women from 1974 to 2000. The patients were divided into two groups: group 1 (142 pregnancies) had warfarin throughout pregnancy; and in group 2 (54 pregnancies), warfarin was replaced by subcutaneous heparin during the first trimester and last two weeks of pregnancy. There were no maternal complications in 129 pregnancies in group 1 and 44 in group 2. There were significantly fewer normal births in group 1 (56; 39.4%) compared to group 2 (39; 72.2%). Group 1 had a significantly higher rate of spontaneous abortion (46.5% vs 14.8%), but group 2 had a higher rate of valve thrombosis. In group 1, women with a warfarin requirement < 5 mg had a lower rate of spontaneous abortion. Warfarin is an effective anticoagulant in pregnant women with mechanical valves but it results in significant fetal loss when the dose is > 5 mg. Heparin is a less effective anticoagulant resulting in more maternal complications, but it is more protective of the fetus.
The most common fungal organism to cause endocarditis is Candida which is followed by Aspergillus. Aspergillus endocarditis can occur in either the native or prosthetic heart valves, usually occurs post-operative after cardiac valve surgery. This case is illustrative of a 49-year-old man with previous history of coronary artery bypass grafting presenting with aortic valve endocarditis which was diagnosed as Aspergillus endocarditis. Unfortunately, despite medical and surgical therapy, progressive fatal aortic invasion occurred.
If tricuspid regurgitation (primary and secondary) is left untreated, it will be associated with significant complications and death, even if left ventricular dysfunctions are corrected, TR does not decrease in many cases. Since many studies have not been conducted in this area, we decided to evaluate the results of tricuspid repair. In this retrospective study conducted since 2006 to 2011, 448 patients undergoing tricuspid surgery with different methods with or without surgery were studied. Statistical analysis was performed by Friedman, Fisher exact and Pearson chi-square methods. In the Mod and Severe RV dysfunction section, the mean age of the patients was 52 years, 289 were female (64%), 343 (76%) had rheumatic pathology, 79 (17%) had myxomatous pathology, 12 (2%) had endocarditis pathology, and 14 had an unknown pathology. Before surgery, Mod and Severe dysfunction was seen in 226 patients (40%) and after surgery (follow up), it was seen in 85 patients (19%). Before surgery, Mod and Severe TR was seen in 356 patients (79%) and after surgery, it was seen in 91 patients (20%). The mean of PAP before surgery was 54 mmHg and after surgery, it was 37 mmHg, which was significant in all cases (P <0.05).
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