Introduction: Since pregnancy in women with pulmonary arterial hypertension (PAH) is associated with a high risk of morbidity and mortality, it is recommended that pregnancy should be avoided in PAH. However, some women with mild PAH may consider this recommendation as unsuitable. Unfortunately knowledge on pregnancy outcomes and best management of PAH during pregnancy is limited.Methods: Data from all women with PAH who were followed during pregnancy by a multidisciplinary team at a tertiary referral center for PAH and who delivered between 2004 and 2020 were retrospectively analyzed in a case series. PAH risk factor profiles including WHO functional class (WHO-FC), NT-pro-BNP, echocardiographic pulmonary arterial pressure (PAP) and right heart function were analyzed prior to, during and following pregnancy.Results: In seven pregnancies of five women with PAH (median age 29 (27; 31) years), there were no abortions or terminations. Five pregnancies were planned (all in WHO-FC I-II), two incidental (WHO-FC II, III). During pregnancy none of the women had complications or clinical worsening of PAH. After a median pregnancy duration of 37 1/7 weeks all gave birth to healthy babies by cesarean section in spinal anesthesia. During pregnancy, PAP tended to increase, whilst the course of WHO-FC and NT-pro-BNP were variable and no trend could be detected.Conclusion: Women with PAH with a low risk profile closely followed by a multidisciplinary team had a favorable course during and after pregnancy, resulting in successful deliveries of healthy newborns.
Hypothermia has marked effects on the electrical activity of the brain, which has been shown in animals as well as in humans. The aim of this study was to investigate EEG spindle activity in children during cardiac surgery and hypothermic cardiopulmonary bypass. The authors obtained intraoperative 21-channel EEG recordings in 36 children (mean age, 22 months; range, 6 days to 69 months) with congenital heart disease. Bipolar EEG derivations were analyzed visually for rhythmic spindle activity based on morphology, frequency, duration, and amplitude. Linear regression analysis for duration, frequency, and amplitude versus rectal temperature was performed in each individual. Spindle activity was observed in 17 children (16 children < 12 months of age). Progressive slowing of spindle frequency with decreasing rectal temperature was found (mean decrease, 0.54 +/- 0.31 Hz/ degrees C). Spindle duration increased on average by 0.69 +/- 0.39 second/ degrees C during cooling procedures. Spindle amplitude did not show any correlation to changes in rectal temperature. The current study demonstrates spindle activity during hypothermic cardiopulmonary bypass with temperature-dependent spindle modifications of frequency and duration. Although the temperature-dependent changes in this study confirm temperature coefficients of other EEG studies, the reasons for the clear age relationship and the "nature" of these spindles remain unknown.
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