Programming standard pacemakers to avoid RV pacing is safe, does not adversely affect patients' symptoms or quality of life and is associated with improved LV function, related to the reductions in RV pacing percentage.
Implantable cardiac electronic device (ICED) infections are a major cause of morbidity and mortality. Understanding the pathogenesis of these infections is important in their prevention and management. We hypothesized that ICED infections could be classified as 'early' or 'late', based on differences in microbiological cause within or beyond 1 year of implantation, respectively. A comprehensive review of the literature was undertaken to test this hypothesis. Prosthetic valve endocarditis cases were included for comparison. Articles were included if the time from device implantation to infection, definite evidence of infection (pocket/bacteraemia/endocarditis) and a positive microbiological diagnosis were included. There were no statistically significant differences in microbiology to support a 1 year cut-off between early and late ICED infection. Staphylococcus aureus and coagulase-negative staphylococci were the predominant causes of ICED infection both within and beyond 1 year of ICED implantation. To further assess the microbiological causes of ICEDs and their implications for pathogenesis a large-scale multicentre study is required.
pPCI is the preferred treatment strategy for STEMI. However, FL with subsequent percutaneous coronary intervention remains a viable option for those in rural areas.
Objective
To determine the characteristics and outcomes of pregnancy in women with Turner syndrome.
Design
Retrospective 20‐year cohort study (2000–20).
Setting
Sixteen tertiary referral maternity units in the UK.
Population or sample
A total of 81 women with Turner syndrome who became pregnant.
Methods
Retrospective chart analysis.
Main outcome measures
Mode of conception, pregnancy outcomes.
Results
We obtained data on 127 pregnancies in 81 women with a Turner phenotype. All non‐spontaneous pregnancies (54/127; 42.5%) were by egg donation. Only 9/31 (29%) pregnancies in women with karyotype 45,X were spontaneous, compared with 53/66 (80.3%) pregnancies in women with mosaic karyotype 45,X/46,XX (P < 0.0001). Women with mosaic karyotype 45,X/46,XX were younger at first pregnancy by 5.5–8.5 years compared with other Turner syndrome karyotype groups (P < 0.001), and more likely to have a spontaneous menarche (75.8% versus 50% or less, P = 0.008). There were 17 miscarriages, three terminations of pregnancy, two stillbirths and 105 live births. Two women had aortic dissection (2.5%); both were 45,X karyotype with bicuspid aortic valves and ovum donation pregnancies, one died. Another woman had an aortic root replacement within 6 months of delivery. Ten of 106 (9.4%) births with gestational age data were preterm and 22/96 (22.9%) singleton infants with birthweight/gestational age data weighed less than the tenth centile. The caesarean section rate was 72/107 (67.3%). In only 73/127 (57.4%) pregnancies was there documentation of cardiovascular imaging within the 24 months before conceiving.
Conclusions
Pregnancy in women with Turner syndrome is associated with major maternal cardiovascular risks; these women deserve thorough cardiovascular assessment and counselling before assisted or spontaneous pregnancy managed by a specialist team.
Tweetable abstract
Pregnancy in women with Turner syndrome is associated with an increased risk of aortic dissection.
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