The predicted spontaneous remission rate with chronic ITP was 30% and 44% at 5 and 10 years, respectively. Platelet count at diagnosis and the treatment administered did not influence remission outcomes. Age <8 years and female gender were predictors of a favorable outcome.

Chest US is an accurate and reproducible bedside method for diagnosing secondary pulmonary lymphangiectasia in patients with pulmonary venous obstruction. These patients may have worse prognoses.

Objective: To assess performance of risk stratification schemes in predicting adverse cardiac outcomes in pregnant women with congenital heart disease (CHD) and to compare these schemes to clinical factors alone.Design: Single-center retrospective study.Setting: Tertiary care academic hospital. Patients: Women ≥18 years with International Classification of Diseases, NinthRevision, Clinical Modification codes indicating CHD who delivered between 1998 and 2014. CARPREG I and ZAHARA risk scores and modified World Health Organization (WHO) criteria were applied to each woman. Outcome Measures:The primary outcome was defined by ≥1 of the following: arrhythmia, heart failure/pulmonary edema, transient ischemic attack, stroke, dissection, myocardial infarction, cardiac arrest, death during gestation and up to 6 months postpartum. Results:Of 178 women, the most common CHD lesions were congenital aortic stenosis (15.2%), ventricular septal defect (13.5%), atrial septal defect (12.9%), and tetralogy of Fallot (12.9%). Thirty-five women (19.7%) sustained 39 cardiac events.Observed vs expected event rates were 9.9% vs 5% (P = .02) for CARPREG I score 0 and 26.1% vs 7.5% (P < .001) for ZAHARA scores 0.51-1.5. ZAHARA outperformed CARPREG I at predicting adverse cardiovascular outcomes (AUC 0.80 vs 0.72, P = .03) but was not significantly better than modified WHO. Clinical predictors of adverse cardiac event were symptoms (P = .002), systemic ventricular dysfunction (P < .001), and subpulmonary ventricular dysfunction (P = .03) with an AUC 0.83 comparable to ZAHARA (P = .66).Conclusions: CARPREG I and ZAHARA scores underestimate cardiac risk for lower risk pregnancies in these women. Of the three risk schemes, CARPREG I performed least well in predictive capacity. Clinical factors specific to the population studied are comparable to stratification schemes. K E Y W O R D Sadult congenital heart disease, outcomes, pregnancy, risk stratification | 471 KIM et al. | INTRODUC TI ONAs survival of those born with congenital heart disease (CHD) shifts toward adulthood, there are a growing number of females with CHD who reach childbearing age. From 1998 to 2007, the proportion of hospitalizations for delivery increased by 34.9% in women with CHD compared to 21.3% in the female general population. 1 Pregnancy outcomes for women with CHD can be highly variable and pose special challenges for congenital cardiovascular specialists and high-risk obstetricians who are tasked with counseling these women and managing them throughout pregnancy, delivery, and postpartum period. Risk stratification schemes predicting adverse outcomes in pregnant women with CHD have been published 2-6 with variable accuracy. 7-12 The objectives of this study were (1) to assess the performance of CARPREG I, ZAHARA, and the modified World Health Organization (WHO) classification in predicting adverse cardiovascular outcomes in women with CHD at a single tertiary care center with an established adult CHD program in an urban North American setting and (2) to compare the...