Characteristics, aetiological spectrum and management of valvular heart disease in a Tunisian cardiovascular centre

Triki, Faten; Jdidi, J.; Abid, Dorra; Tabbabi, Nada; Charfeddine, S.; Kahla, Sahar Ben; Hentati, Mourad; Abid, Leïla; Kammoun, S.

doi:10.1016/j.acvd.2016.08.003

Cited by 13 publications

(15 citation statements)

References 23 publications

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“…Whereas congenital heart disease is more common in Europe and North America, rheumatic disease predominates in other parts of the world, particularly those that are underrepresented in the STS-CHSD. 2,12,13 A 2009 AVR study from Saudi Arabia demonstrated 58% of patients had rheumatic AV pathology, compared with 0.5% in the current study. 2 Likewise, the proportion of patients with connective tissue disorders such as Marfan syndrome influences valve choice.…”

Section: Valve Choicecontrasting

confidence: 43%

National Practice Patterns and Early Outcomes of Aortic Valve Replacement in Children and Teens

Nelson

Maul

Wearden

et al. 2019

The Annals of Thoracic Surgery

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Background. Several options exist for aortic valve replacement (AVR) in children and teens, but contemporary practice patterns and outcome data are lacking. We describe national AVR practice patterns and early outcomes.Methods. Children (aged 1 to 18 years) in The Society of Thoracic Surgeons Congenital Heart Surgery Database undergoing AVR from 2000 to 2016 were included. Preoperative characteristics, operative data, and outcomes were described. To evaluate practice patterns, centers were assigned tertiles by aortic valve surgical volume. Statistical comparisons included Mann-Whitney U statistic, Kruskal-Wallis, c 2 test, and gamma testing.Results. In total, 3446 operations (46% children aged 1 to 12 years; 54% teens aged 12 to 18 years) were included. Preoperative risk factors were present in 23%, and 46% had a prior sternotomy. Valve utilization included autograft (64% child, 37% teen), mechanical (19% child, 35% teen), bioprosthetic (8% child, 20% teen), and homograft (9% child, 7% teen). Autografts were utilized more often for teenage girls than for teenage boys (odds ratio 1.3, 95% confidence interval: 1.05 to 1.66, P < .05). Overall, inpatient mortality and major complications affected 1% and 10%, respectively, and these rates were highest for homografts (5%, P < .001, and 13%, P < .05). Autograft utilization varied widely across centers (10th to 90th percentile: 21% to 71% of total AVR volume). More autografts were utilized at high-volume centers vs low-or medium-volume centers (53% ± 2.3% vs 46% ± 2.6%, P < .001).Conclusions. Practice patterns for AVR in children and teens vary across centers, age groups, and sexes. Although early outcomes were similar across valve types, homografts had higher morbidity and mortality. Valve choice was related to aortic valve surgical volume. Further efforts are needed to understand and optimize AVR practice patterns and long-term outcomes.

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Section: Valve Choicecontrasting

confidence: 43%

National Practice Patterns and Early Outcomes of Aortic Valve Replacement in Children and Teens

Nelson

Maul

Wearden

et al. 2019

The Annals of Thoracic Surgery

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“…In fact, pregnancy period is characterized by an increase of cardiac output brought by increased heart rate and stroke volume, and oppositely a decrease of peripheral resistance by a peripheral vasodilatation. The drop of vascular resistance explains the tolerance of regurgitant lesions [6,[24][25][26].…”

Section: Discussionmentioning

confidence: 99%

“…The World Health Organisation (WHO) considers severe stenotic valve heart disease as a contraindication to conception (WHO IV category) [5]. Giving that rheumatic heart disease remains prevalent in our country [6], managing pregnant women with such conditions is still encountered in our daily practice and is a challenging situation for obstetricians, cardiologists and anaesthesiologists. In fact, we have to deal with two main challenges; the rst one is: should we opt for stopping the pregnancy considering maternal and foetal risks.…”

Section: Introductionmentioning

confidence: 99%

Predictors of maternal and neonatal complications in patients with severe valve heart disease during pregnancy: a retrospective cohort study

Hammami

Hadj

Mejdoub

et al. 2021

Preprint

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Background: The severe valve disease especially stenosis is a contraindication to conception according to World Health Organization. This situation is still encountered in countries with a high rheumatic fever prevalence. The objective of this study is to determine the predictors of maternal cardiac, obstetric and neonatal complications.Methods: This is an observational study of all pregnant women with severe valvulopathy, delivered between 2010 and 2017.Results: We included 60 pregnancies in 54 women. Cardiac complications occurred in 37 patients (61%). In multivariate analysis, the predictors of these complications were parity (OR = 2.41, p = 0.023), revelation of valvulopathy by pregnancy (OR = 6.34, p = 0.025), severe mitral stenosis (OR= 6.84, p= 0.035) and systolic pulmonary arterial pressure (OR = 1.08, p= 0.01). Obstetrical complications were noted in 19 women (31.8%). The predictors of these complications were primiparity (OR = 5.22, p = 0.032), multiple valve disease (OR = 5.26, p = 0.028), systolic pulmonary arterial pressure (OR = 1.04, p = 0.04) and treatment with vitamin K antagonist (OR = 8.71, p = 0.04). Neonatal complications were noted in 39% of new-borns. The predictors of these complications were the occurrence of obstetric complications (OR = 15.48, p = 0.001) and the revelation of valvulopathy by pregnancy (OR = 6.95, p = 0.017).Conclusions: The revelation of valve disease by pregnancy is a predictor not only of cardiac complication but also of neonatal complications, thus valve disease screening during pre-conceptional counselling is so crucial.

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“…In fact during pregnancy there will be an increase of cardiac output brought by increased heart rate and stroke volume, and oppositely a decrease of peripheral resistance by a peripheral vasodilatation. The drop of vascular resistance explains the tolerance of regurgitant lesions (6,(24)(25)(26).…”

Section: Cardiac Adverse Eventsmentioning

confidence: 99%

“…The World Health Organisation considers severe stenotic valve heart disease as a contraindication to conception (WHO IV category) (5). Giving that rheumatic heart disease remains prevalent in our country (6), managing pregnant woman such conditions is still encountered in our daily practice and is a challenging situation for obstetricians, cardiologists and anaesthesiologists. We have to deal in this situation with two main challenges; rst should we advise to stop the pregnancy taking in consideration the maternal and foetal risk.…”

Section: Introductionmentioning

confidence: 99%

Predictors of Maternal and Neonatal Complications in Patients With Severe Valve Heart Disease During Pregnancy

Hammami

BELHADJ

Mejdoub

et al. 2020

Preprint

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Background: The severe valve disease especially stenosis is a contraindication to conception according to WHO. This situation is still encountered in countries with a high rheumatic fever prevalence. The objective of this study was to determine the predictors of maternal cardiac, obstetric and neonatal complications. Methods: This is an observationnal study of all pregnant women with severe valvulopathy, delivered between 2010 and 2017. Results: We included 60 pregnancies in 54 women. Cardiac complications occurred in 37 patients (61%). In multivariate analysis, the predictors for these complications were parity (OR = 2.41, p = 0.023), revelation of valvulopathy by pregnancy (OR = 6.34, p = 0.025), severe mitral stenosis (OR = 6.84, p = 0.035) and systolic pulmonary arterial pressure (OR = 1.08, p = 0.01). Obstetrical complications were noted in 19 women (31.8%). The predictive factors for these complications were primiparity (OR = 5.22, p = 0.032), multiple valve disease (OR = 5.26, p = 0.028), systolic pulmonary arterial pressure (OR = 1.04, p = 0.04) and treatment with vitamin K antagonist (OR = 8.71, p = 0.04). Neonatal complications were noted in 39% of new-borns. The predictive factors for these complications were the occurrence of obstetric complications (OR = 15.48, p = 0.001) and the revelation of valvulopathy by pregnancy (OR = 6.95, p = 0.017). Conclusions: The revelation of valve disease by pregnancy is predictor of not only cardiac complication but also neonatal complications, thus valve disease screening during pre-conceptional counselling is crucial.

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Characteristics, aetiological spectrum and management of valvular heart disease in a Tunisian cardiovascular centre

Cited by 13 publications

References 23 publications

National Practice Patterns and Early Outcomes of Aortic Valve Replacement in Children and Teens

National Practice Patterns and Early Outcomes of Aortic Valve Replacement in Children and Teens

Predictors of maternal and neonatal complications in patients with severe valve heart disease during pregnancy: a retrospective cohort study

Predictors of Maternal and Neonatal Complications in Patients With Severe Valve Heart Disease During Pregnancy

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