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.
Considering the statistically effective role of silymarin in alleviating the severity of allergic rhinitis symptoms, applying this herbal antioxidant along with other medications may result in better management.
Diffuse or unresectable subaortic stenosis is difficult to treat and needs aggressive resection to effectively relieve the obstruction. Anterior aortoventriculoplasty, known as the Konno-Rastan procedure, has been shown to effectively tackle the problems encountered in diffuse subaortic stenosis. A retrospective study was carried out on patients who had undergone a Konno-Rastan procedure at our institution from March 1997 to November 2003. There were 26 patients (16 males and 10 females). The mean age at operation was 12.8 +/- 7 years. The mean follow-up period was 30.4 +/- 14.5 months. Only mechanical valves were used in this group of patients. The overall 30-day mortality was 11.5% (3 patients). The mean preoperative peak systolic gradient decreased significantly from 91.3 +/- 39.3 to 28.1 +/- 17.7 mm Hg. Four patients developed permanent complete heart block and 2 had a residual ventricular septal defect in late follow-up. The classic Konno-Rastan procedure using a mechanical valve can be performed with acceptable morbidity and mortality in this difficult group of patients.
Introduction Epicardial pacemakers are known as an alternative for endocardial pacemakers in some cases such as heart block, and complex congenital heart diseases. Considering recent advances and improvement of epicardial lead subtypes, it is essential to investigate the long‐term function of them. In this study, we aimed to assess the sensing and pacing characteristics, and survival of bipolar steroid‐eluting and unipolar nonsteroid‐eluting epicardial pacemakers. Methods We conducted an entirely concentrated search on the documents of all patients who had undergone epicardial lead implantation in the Shaheed Rajaie Cardiovascular, Medical & Research Center during 2015–2018. Implant, and follow‐up data were extracted. Kaplan–Meier analysis and Weibull regression hazards model were applied for the survival analysis. Results Eighty‐nine leads were implanted for 77 patients. Of the total leads, 52.81%, 53.93%, and 47.19% were implanted in children (under 18‐year‐old), females, and patients with congenital heart diseases, respectively. Bipolar steroid‐eluting leads comprised 33.71% of 89 leads. The pacing threshold of unipolar nonsteroid‐eluting leads that were implanted on the left ventricle and right atrium increased significantly during the follow‐up to greater records than bipolar steroid‐eluting leads. Survival analysis also revealed that bipolar steroid‐eluting leads are significantly better in 48‐month survival (Weibull hazard ratio [HR]: 0.13 (95% confidence interval [CI]: 0.02–0.99), p = .049). Age, ventricular location of the lead, and acute pacing characteristics were not associated with survival. Conclusions Bipolar steroid‐eluting epicardial leads have an acceptable survival compared with unipolar nonsteroid‐eluting, without a significant difference regarding patients age. Therefore, they could be an excellent alternative for endocardial ones.
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