Aims To evaluate the feto-maternal outcome, identify the adverse outcome predictors and test the applicability of modified WHO (mWHO) classification in pregnant women with heart disease (PWWHD) from Tamil Nadu, India. Methods and results One thousand and five pregnant women (mean age: 26.04 ± 4.2) with 1029 consecutive pregnancies were prospectively enrolled from July 2016 to December 2019 in the Madras medical college pregnancy and cardiac (M-PAC) registry. Majority (60.5%; 623/1029) had heart disease (HD) diagnosed for the first time during pregnancy. Rheumatic HD (42%; 433/1029) was most common. One third (34.2%; 352/1029) had pulmonary hypertension (PH). Maternal mortality and composite maternal cardiac events (MCEs) were the primary outcomes. Secondary outcomes were foetal loss and composite adverse foetal events (AFEs). MCEs occurred in 15.2% (156/1029; 95% CI: 13.0–17.5) pregnancies. Heart failure was the most common MCE (66.0%; 103/156; 95% CI: 58.0–73.4). Maternal mortality was 1.9% (20/1029; 95% CI: 1.1–2.8), with highest rates in patients with prosthetic heart valves (PHVs) (8.6%; 6/70). Left ventricular systolic dysfunction (LVSD), PHVs, severe mitral stenosis, PH and current pregnancy diagnosis of HD were independent predictors of MCE. The c-statistic of mWHO classification for predicting MCE and maternal death were 0.794 (95% CI: 0.763–0.826) and 0.796 (95% CI: 0.732–0.860). 91.2% (938/1029; 95% CI: 89.392.8) of pregnancies resulted in live births. 33.7% (347/1029; 95% CI: 30.8–36.7) of pregnancies reported AFEs. Conclusion Maternal mortality is high in PWWHD from India. Highest death rates occurred in women with PHVs, PH and LVSD. The mWHO classification for risk stratification may require further adaptation and validation in India.
Foreign body in the superior mediastinum following a fall on a box is uncommon. We present a 27 years old woman with history of fall on a box containing embroidery needles 3 years ago. Chest Xray and fluoroscopy revealed two needles; one at the left parasternal subcutaneous plane was removed and advised removal of the second needle at the superior mediastinum. She defaulted and came after a recent trivial chest injury. After confirmation, by thoracotomy, a rusted needle (of 1 in. size) embedded between the trachea and superior vena cava was removed. The longer asymptomatic period and the migration of the needle from anterior to posterior chest without injuring vital structures is a rarity.
Primary Intracardiac thrombosis in the absence of indwelling catheters or pacemaker etc. is an uncommon complication.Although cases of primary coronary sinus thrombosis are reported, most cases occur due to endothelial damage following invasive cardiac procedures involving the right atrium, such as Central Venous Pressure (CVP) placement, Right Ventricle (RV) pacing, cardiac resynchornising therapy and cardiac transplant.We report the case of a 31 yr -old woman, who was admitted with chest discomfort and exertional dyspnea and was found by investigation to have Systemic Lupus Erythematosus (SLE) with secondary antiPhospholipid antibody syndrome. Subsequent 64 slice spiral computerised tomography showed pulmonary embolism. In addition, Trans-Thoracic Echocardiography (TTE) and Trans-Esophageal Echocardiography (TEE) revealed an hyperechoic signal highly suggestive of tumor/thrombus at an unusual site, namely the coronary sinus. The patient underwent surgery under cardiopulmonary bypass and moderate hypothermia. The organized calcified tumor/thrombus was removed through trans-atrial approach and an 8mm Polytetrafluoroethylene (PTFE) graft was placed at the coronary sinus opening. Histological examination of the specimen obtained from the coronary sinus showed an organised, partiallycalcified thrombus. In our patient, pre-operative investigations could not differentiate a thrombus from a mass and the definitive diagnosis was made post-operatively.Keywords Thrombosis . Cardiac . Cardiopulmonary bypass Case reportIn May 2009, a 31 year-old woman presented at the emergency room of our hospital with sudden-onset chest discomfort and exertional dyspnoea of class III severity (New York Heart Association criteria). The patient was a known hypothyroid for last 2 years, for which she had been on supplementary dose of thyroxine (100 μg/day). She was recently diagnosed to have hypertension and was on medical treatment.At the time of presentation in May 2009, physical examination revealed a blood pressure of 160/100 mm Hg, heart rate of 100/min and respiratory rate of 24/min. The jugular venous pressure was not elevated. First and second heart sounds were regular, but the pulmonic component of 2nd heart sound (P2) was accentuated. The lungs were clear and the abdomen was soft; no peripheral oedema was found. Acanthosis nigricans and livedo reticularis, markers of autoimmunity, were noted. A chest radiograph showed a normal-sized heart with a relative decrease in right-sided bronchovascular markings, a finding suggestive of segmental pulmonary artery occlusion. Electrocardiogram (ECG) showed sinus tachycardia with right-axis deviation (mean frontal plane QRS axis of 105 degrees) and symmetrical 'T' inversion in right sided precordial leads (V1, V2, and V3). Colour Doppler and duplex scan ultrasonogram of the lower limbs excluded deep vein thrombosis.Two dimensional Echocardiography (Philips HD7 ultrasound system, 2-5 MHz transducer) revealed normal left ventricular and left atrial dimensions. Aortic and mitral
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