Navegando por Palavras-chave "maternal-fetal health"

Agora exibindo 1 - 1 de 1
  • Imagem de Miniatura
    Item
    Acesso aberto (Open Access)
    Dissecção espontânea de artéria coronária no ciclo gravídico-puerperal: análise de uma série de 13 casos e revisão da literatura
    (Universidade Federal de São Paulo (UNIFESP), 2016-11-29) Cade, Jamil Ribeiro [UNIFESP]; Caixeta, Adriano Mendes [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)
    Objectives: This study aims a descriptive analysis of 13 cases of SCAD in the peripartum period, based on the emphatic observation of clinical and epidemiological data, previous pregnancy history, clinical and angiographic presentation on admission, treatment in acute phase and in-hospital follow-up. Additionally to the study a review of all published cases of this disease, from 1952 to 2015, with evaluation using the same data cited above. Methods: A retrospective and observational study including patients with peripartum SCAD, using database of 15 tertiary hospitals. The diagnosis of SCAD was given through the agreement of two interventional cardiologists, using angiographic existing diagnosis criteria. The assessment of all cases from 1952 to 2015 was research through Pubmed, Web of Science, Embase and Cochrane Library. Age, risk factors for CAD, gestational history, clinical presentation, angiographic data and treatment as well as maternal and fetal outcomes at hospital discharge, were stored for later analysis. Results: All 13 cases of SCAD were reported descriptively. The mean age was 33.8 ± 3.7 years, mean of pregnancies were 1.8 ± 0.7 and births 1.7 ± 0.8. Twelve SCAD patients occurred in postpartum period and only one in the 37th week of pregnancy. The clinical presentation was myocardial infarction in 92.3%. Most were kept in clinical treatment alone (53.8%), followed by coronary angioplasty in 30.7%. There was one maternal death (7.7%) due to cardiogenic shock. In the review of all cases of peripartum SCAD from 1952 to 2015 were identified 133 more cases. Of this total an average age was 33.4 ± 5 years, mean 2.5 ± 1.5 pregnancies and 1.9 ± 1.3 deliveries. The postpartum period accounted for 75.3% of SCAD, with a median of 10 days after delivery. In pregnant women with SCAD (21.2%) the median was 34 weeks. The majority (65.1%) had no risk factors for CAD. Of the total cases, STEMI represented 61%, Non-STEMI 19.8%, angina 4.1% and sudden death in 13.7% of cases. LAD isolated was the most affected (35%), but the involvement of LM occurred in 29.4%, and two or more arteries compromises 44% patients. The isolated clinical treatment occurred in 33%, PCI in 20% and CABG in 21% of cases. Heart transplant occurred in 2%. The hospital mortality rate was 18.5% on 146 analyzed patients. Conclusions: Although it is a rare, underdiagnosed, and potentially fatal disease, the peripartum SCAD is often presented as STEMI on young patients with few or no risk factors for CAD. Mainly affects the LAD, but the involvement of multiple vessels occurs in about a half of cases and LM in almost one-third cases. Compared to historical cases, we observed a favorable maternal and fetal survival over the years, probably with the advancement in the management of acute STEMI and better understanding of SCAD, manly in the last decade.