RESUMEN
Objetive: Congenital heart diseases (CHD) can be found in pregnant women. Although cardiac interventions in the catheterization laboratory are considered safe and effective, it is preferable to wait 3-6 months after delivery to correct simple, uncomplicated CHD; however, this may result in follow-up losses. The objective is to present our experience in correcting CHD during the early puerperium (EP). Materials and methods: All cases of pregnant women with CHD, including atrial septal defect (ASD), patent ductus arteriosus (PDA), and aortic coarctation (CoA) between 2017-2023, who underwent percutaneous defect correction during the EP were collected. Results: Fifteen pregnant women were included, diagnosed with ASD (5), PDA (6), and CoA (4). Five patients (33.3%) were classified as WHO risk class IV; the procedure was successful in 80% of the cases, and only 1 patient presented complications. Conclusions: In our experience, the closure of uncomplicated congenital defects during the EP did not present major complications and could be a treatment strategy to prevent follow-up losses after delivery in pregnant women with CHD.
RESUMEN
Abstract Introduction: Pregnant women with mechanical prosthetic valves (MPVs) have a higher risk of complications. We set out to identify and describe the main complications of pregnant women with MPVs, whether these are preventable, and their impact on cardiovascular, obstetric and fetal outcomes. Materials and methods: An analytical, observational study of a prospective cohort at a cardiac-obstetric clinic. The registry began in January 2016 and continues to date. This study reports the main cardiovascular, fetal and obstetric outcomes in pregnant women with MVPs included in the registry up to November 2021. We evaluated maternal, cardiac, obstetric, neonatal and safety outcomes. Results: From January 1, 2016, to November 1, 2021, 22 patients with a mechanical prosthetic valve who underwent 22 pregnancies were included in the REMEC. The mean age was 26.5 years (IQR 14-40). The median CARPREG II was 6 points, 86% were classified as mWHO class III and 14% were in class IV; 72.7% (16) had inadequate anticoagulation on admission, 18.1% (4) were not on any anticoagulant on admission, 40.9% (9) used VKAs and 40.9% (9) were on low molecular weight heparin. There was a 100% survival rate during follow up; however, the rate of complications was high. We found only four women (18%) with no obstetric or neonatal primary or secondary cardiac outcome. Primary cardiac events occurred in 18.1% of the patients, secondary cardiac events in 13%, obstetric outcomes in three (13.6%) and neonatal events in 45.4% (10). Fifty-nine percent of the patients had late evaluations. We found mechanical valve thrombosis in 36.3%. Conclusions: In our experience, although all the pregnant women survived, the rate of complications was high, with a higher proportion of neonatal complications. We found a high percentage of late evaluation, inadequate anticoagulation and preventable events. (Acta Med Colomb 2022; 48. DOI:https://doi.org/10.36104/amc.2023.2720).
Resumen Introducción: La gestante intervenida con prótesis valvular mecánica (PVM) tiene un mayor riesgo de complicaciones. Nos propusimos identificar y describir las principales complicaciones que se presentan en la embarazada con PVM, el carácter prevenible o no de éstas y su impacto en desenlaces cardiovasculares, obstétricos y fetales. Material y métodos: Estudio observacional analítico de una cohorte prospectiva en una clínica cardio- obstétrica. El registro comenzó en enero de 2016. El presente estudio informa los principales desenlaces cardiovasculares, fetales y obstétricos en embarazadas con PVM incluidas desde el inicio del registro hasta noviembre de 2021. Evaluamos desenlaces maternos, cardiacos y obstétricos, neonatales y de seguridad. Resultados: Entre el 1°. de enero de 2016 y el 1°. de noviembre de 2021 se incluyeron en el REMEC 22 pacientes con prótesis valvular mecánica que se sometieron a 22 embarazos. La edad media fue de 26.5 años (RIQ 14 - 40). Una mediana de CARPREG II de seis puntos, 86% estaban clasificadas como OMSm clase III y 14% en clase IV; 72.7% (16) tenían anticoagulación inadecuada al ingreso, 18.1% (4) no recibían ninguna terapia anticoagulante al ingreso, 40.9% (9) usaban AVK y 40.9% (9) venían con esquema de heparina de bajo peso molecular. Hubo una tasa de supervivencia de 100% durante el seguimiento. Sin embargo, la tasa de complicaciones fue alta. Encontramos solo cuatro mujeres (18%) sin desenlace cardiaco primario o secundario, obstétrico o neonatal. Se presentaron eventos cardiacos primarios en 18.1% de los pacientes, eventos cardiacos secundarios en 13%, desenlaces obstétricos en tres (13.6%) y en 45.4% (10) se presentaron eventos neonatales. Valoraciones tardías en 59% de las pacientes. Observamos trombosis valvular mecánica en 36.3%. Conclusiones: En nuestra experiencia, a pesar de la supervivencia de todas las maternas, la tasa de complicaciones fue alta; con una mayor proporción de complicaciones neonatales. Encontramos un alto porcentaje de valoración tardía, anticoagulación inadecuada y de eventos prevenibles. (Acta Med Colomb 2022; 48. DOI:https://doi.org/10.36104/amc.2023.2720).
RESUMEN
BACKGROUND: Alteration of vitamin D is a risk factor for tuberculosis (TB). AIM: To evaluate the pulmonary and serum levels of 25-hydroxy vitamin D (25OHD) in patients with and without pulmonary TB. METHODS: Two-stage study: the first part was retrospective cross-sectional and the second prospective. Those > 18 years of age who underwent fiberoptic bronchoscopy for suspected pulmonary TB and in whom the infection was confirmed were included. Patients with another type of infection without TB and non-infectious diseases were taken as controls for the first stage and infectious controls without TB in the prospective phase. The measurement of 25OHD was performed by ELFA (enzyme-linked fluorescence assay). The Kruskal-Wallis test was used to evaluate association, considering a value of p < 0.05 to be significant. The data were processed with the SPSS version 23 program. RESULTS: The total sample was 77 patients (35 in the first stage and 42 in the second). The characteristics between the groups were homogeneous. Serum (second phase) and broncho-alveolar lavage (first and second phase) levels of 25OHD were lower in TB patients compared to controls and were independent of serum calcium level (serum: 22.4 ng/mL vs 33 ng/mL, p = 0.006 and broncho-alveolar lavage: 9.7 ng/mL vs 12.2 ng/mL; p = 0.012). CONCLUSIONS: There was a significant difference between the levels of 25OHD in both serum and broncho-alveolar lavage in patients with pulmonary TB in relation to their controls.
Asunto(s)
Tuberculosis Pulmonar , Deficiencia de Vitamina D , Estudios Transversales , Humanos , Estudios Prospectivos , Estudios Retrospectivos , Irrigación Terapéutica , Vitamina DRESUMEN
INTRODUCCIÓN: La alteración de la vitamina D es un factor de riesgo para enfermar de tuberculosis (TBC). OBJETIVO: Evaluar la concentración pulmonar y sérica del compuesto 25-hidroxi-vitamina D (25OHD) en pacientes con y sin TBC pulmonar. METODOLOGÍA: Estudio de dos etapas: la primera parte fue de corte transversal, retrospectiva, y la segunda prospectiva. Se incluyeron > 18 años a los que se les realizó fibrobroncoscopia por sospecha de TBC pulmonar y en quienes se confirmó la infección. Se tomaron como controles a pacientes con otro tipo de infección no TBC, y enfermedades no infecciosas para la primera etapa y controles infecciosos sin TBC en la fase prospectiva. La medición de 25OHD se realizó mediante ELFA (ensayo de fluorescencia ligado a enzima). Se empleó la prueba de Kruskal-Wallis para evaluar asociación considerando significativo un valor de p < 0,05. Los datos se procesaron con el programa SPSS versión 23. RESULTADOS: La muestra total fue de 77 pacientes (35 en la primera etapa y 42 en la segunda). Las características entre los grupos fueron homogéneas. Las concentraciones en suero (segunda fase) como en el lavado bronco-alveolar (primera y segunda fase) de 25OHD fueron más bajas en pacientes con TBC comparado con los controles e independientes de la concentración de calcio sérico (suero: 22,4 ng/mL vs 33 ng/mL, p = 0,006 y lavado bronco-alveolar: 9,7 ng/mL vs 12,2 ng/mL; p = 0,012). CONCLUSIONES: Hubo una diferencia significativa entre las concentraciones de 25OHD, tanto en suero como en lavado bronco-alveolar, en pacientes con TBC pulmonar con relación a sus controles.
BACKGROUND: Alteration of vitamin D is a risk factor for tuberculosis (TB). AIM: To evaluate the pulmonary and serum levels of 25-hydroxy vitamin D (25OHD) in patients with and without pulmonary TB. METHODS: Two-stage study: the first part was retrospective cross-sectional and the second prospective. Those > 18 years of age who underwent fiberoptic bronchoscopy for suspected pulmonary TB and in whom the infection was confirmed were included. Patients with another type of infection without TB and non-infectious diseases were taken as controls for the first stage and infectious controls without TB in the prospective phase. The measurement of 25OHD was performed by ELFA (enzyme-linked fluorescence assay). The Kruskal-Wallis test was used to evaluate association, considering a value of p < 0.05 to be significant. The data were processed with the SPSS version 23 program. RESULTS: The total sample was 77 patients (35 in the first stage and 42 in the second). The characteristics between the groups were homogeneous. Serum (second phase) and broncho-alveolar lavage (first and second phase) levels of 25OHD were lower in TB patients compared to controls and were independent of serum calcium level (serum: 22.4 ng/mL vs 33 ng/mL, p = 0.006 and broncho-alveolar lavage: 9.7 ng/mL vs 12.2 ng/mL; p = 0.012). CONCLUSIONS: There was a significant difference between the levels of 25OHD in both serum and broncho-alveolar lavage in patients with pulmonary TB in relation to their controls.