Effect Of Congenital Heart Disease On Reproductive Health Biology Essay

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Worsening functional class and increased severity of heart defects significantly increased the proportion of patients with increased or altered symptoms related to their heart defect during sexual activity reported increased or altered symptoms related to their heart defect during sexual activity reported increased or altered symptoms related to their heart defect during sexual activity reported increased or altered symptoms related to their heart defect during sexual activity reported increased or altered symptoms related to their heart defect during sexual activity

reported increased or altered symptoms related to their heart defect during sexual activity Increased severity Worsening functional class Worsening functional class Worsening functional class Worsening functional class Worsening functional class Top of Form

Various studies have shown that different biopsychosocial periods in a woman's life are all interactively associated with the cardiovascular system. In this regard, the present study was designed to address questions related to sexuality and reproductive health in a large cohort of women with congenital heart disease.

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Matthäus Vigl and his team of researchers conducted this study in 536 women (median age 29 years, range 18 to 75) who completed a questionnaire during their visit at 2 tertiary care centers for congenital heart disease. These patients were categorized according to their functional class and according to the degree of severity of the underlying heart defect.

From the data collected, the researchers made the following observation -

The median age at menarche was significantly delayed in patients with functional class III-IV and in women with complex or cyanotic anomalies.

More than 1/4 of the women (29%) had at least once sought medical advice for menstrual discomforts, and the proportion was significantly increased for those in the worst functional class and for patients with a cyanotic heart defect (table).

Proportion of women who sought medical advice for menstrual discomforts

p

Patients with worst functional class

49%

<0.001

patients with a cyanotic heart defect

43%

0.03

Overall, 9% reported increased or altered symptoms related to their heart defect during sexual activity. This proportion increased significantly with -

Worsening functional class (p = 0.001)(fig 1)

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Increased severity (p = 0.005) (fig 2)

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In women with cyanosis (p <0.001) (fig 3)

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In conclusion, to ensure high-quality care for this demanding and growing patient population, physicians must be aware that issues related to the entire reproductive cycle should be considered when counseling these patients.

Source: Am J of Cardiology 2010

Cat: congenital heart disease

Comparative study of anatomic, imaging and clinical characteristics of Double-Inlet, Double-Outlet Right Ventricle(DI-DORV) with double-inlet left ventricle

Des: DI-DORV is a distinct type of functional single ventricle congenital heart disease with variable atrioventricular valve morphology and myocardial architecture

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Susan F. Saleeb and his colleagues carried out this study to characterize the morphologic, imaging, and clinical characteristics of double-inlet, double-outlet right ventricle (DI-DORV), a rare congenital heart disease, and to compare these findings to those in patients with double-inlet left ventricle (DILV).

The researchers reviewed the clinical records, imaging studies, and heart specimens of 22 consecutive patients with DI-DORV. A comparison group of 44 patients with DILV was matched by age at latest follow-up.

The results of the study showed that -

Among the 22 patients with DI-DORV, 14 had clinical data, 5 had clinical and autopsy data, and 3 had only autopsy data.

Abdominal and atrial situs were normal in all, and heart position was levocardia in 91%.

The morphology of the atrioventricular valves was variable, with 15 patients showing neither a typical tricuspid nor mitral valve.

In the remaining 7 patients, 1 or both atrioventricular valves resembled a tricuspid or a mitral valve.

Myocardial architecture was characterized by atypical muscle bundles of varying degrees of hypertrophy and orientation.

Most patients had bilateral conus, and 82% had either aortic or pulmonary outflow tract obstructions.

The rate of overall mortality or heart transplantation was 36%.

Significant differences between DI-DORV and DILV included the type of ventricular loop, the type of conus, and a higher mortality rate in patients with DI-DORV.

Based on this data the study concluded that DI-DORV is a distinct type of functional single ventricle congenital heart disease with variable atrioventricular valve morphology and myocardial architecture.

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Thus accurate diagnosis using noninvasive imaging techniques is of paramount importance for optimal management.

Source: Am J of Cardiology 2010

Cat: IC

Complication rates of arteriotomy closure device among patients with chronic kidney disease

Des: The researchers showed that worsening renal function is associated with higher vascular access site complications

Various studies have shown that arteriotomy closure device (ACD) use has increased following percutaneous transfemoral coronary procedures (PTCP). Since their safety in patients with chronic kidney disease (CKD) is not known, Emad F. Aziz and colleagues, evaluated the complication rates of ACD among patients with CKD.

The study population comprised of 610 consecutive patients who underwent PTCP and ACD These patients were grouped according to their creatinine clearance (CrCl in ml/min/1.73 m2) using the National Kidney Foundation classification system; Stage I (CrCl ≥ 90); Stage II (60-89); Stage III (30-59); Stage IV (15-29); and Stage V (≤ 15).

The data obtained from the study reported the following findings -

Among 610 patients 283 (46%) underwent PCI.

The primary endpoint - the combined incidence of pseudo-aneurysm, retroperitoneal hematoma, femoral artery thrombosis, surgical vascular repair, and groin infection, was seen in 66 (10.8%) patients.

Univariate predictors of primary outcome were lower CrCl (p < 0.001), and presence of peripheral vascular disease (p = 0.03).

There was an inverse relationship between CrCl and complication rate.

CKD was the strongest independent multivariate predictor for the primary endpoint (table), driven by higher infection (p < 0.0001), thrombosis (p = 0.003) and hematoma (p = 0.007).

OR

95% CI

p

1.032

1.019-1.046

< 0.0001

In conclusion, renal function appears to be significantly associated with vascular access-site complications. Whereas, worsening renal function is associated with higher vascular access site complications, largely driven by an increased infection rate.

Source: J Invasive Cardiol 2010

Cat: Others

Body weight changes in patients with morbid obesity were associated with changes in LV structure independent of improvement in obesity-related co-morbidities

Des: Weight loss improved the RV end-diastolic area and might prevent progression to RV dysfunction

Previous studies have shown that obesity and bariatric surgery have been associated with changes in ventricular function and structure.

In this light, the present study aimed to assess the long-term changes in left ventricular (LV) and right ventricular (RV) function and structure in patients with morbid obesity-body mass index ≥40 kg/m2 or ≥35 kg/m2 with co-morbidities-who had lost weight after bariatric surgery compared to nonsurgical controls.

As part of the study protocol, Carolina A. Garza and colleagues reviewed 57 patients with morbid obesity who had undergone gastric bypass surgery and who had undergone echocardiography before and after surgery. A reference group (n = 57) was frequency matched for body mass index (±2 kg/m2), gender, age (±2 years), and follow-up duration (±6 months).

After a mean follow-up of 3.6 years, the following results were reported -

The LV mass and LV mass indexed by height had decreased in the patients who had undergone bariatric surgery and had lost weight. In contrast, these measurements had increased in the patients who had not undergone bariatric surgery.

The difference between these 2 groups remained significant after adjusting for potential confounders.

Neither the patients nor controls showed a significant change in ejection fraction, LV myocardial performance index, or RV myocardial performance index.

Multivariate analysis showed a positive correlation between the change in body weight and ventricular septum thickness, posterior wall thickness, LV mass, RV end-diastolic area and estimated RV systolic pressure (table).

ventricular septum thickness

posterior wall thickness

LV mass

RV end-diastolic area

estimated RV systolic pressure

R

0.33

0.31

0.38

0.22

0.39

P

<0.05

<0.05

<0.05

<0.05

<0.05

In conclusion, body weight changes in patients with morbid obesity were associated with changes in LV structure independent of improvement in obesity-related co-morbidities, including obstructive sleep apnea. Weight loss improved the RV end-diastolic area and might prevent progression to RV dysfunction.

Source: Am J of Cardiology 2010

Diabetovalens

Cat: pregnancy and diabetes

Association of maternal glycemia with birth weight and risk of large-for-gestational-age babies in mothers with normal glucose tolerance

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Des: Both low and high fasting glucose values at 22-30 weeks of gestation are associated with increased risk of an LGA newborn

Numerous studies have shown that gestational diabetes is a risk factor for large-for-gestational-age (LGA) newborns, but many LGA babies are born to mothers with normal glucose tolerance.

To clarify the association of maternal glycemia across the whole distribution with birth weight and risk of LGA births in mothers with normal glucose tolerance, Zsuzsa Kerényi and co-workers conducted the study in 3,787 women with singleton pregnancies of mothers ≥18 years of age, without known diabetes or gestational diabetes (World Health Organization criteria). Mean ± SD maternal age was 30 ± 4 years, BMI was 22.6 ± 4.0 kg/m2, fasting blood glucose was 4.5 ± 0.5 mmol/l, and postload glucose was 5.5 ± 1.0 mmol/l.

Data on a 75-g oral glucose tolerance test at 22-30 weeks of gestation, were included and the LGA was then determined as birth weight greater than the 90th percentile

The results thus obtained showed that -

The mean birth weight was 3,450 ± 476 g at 39.2 ± 1.2 weeks of gestation.

There was a U-shaped association of maternal fasting glucose with birth weight (Pcurve = 0.004) and risk of having an LGA baby (lowest values between 4 and 4.5 mmol/l, Pcurve = 0.0004) with little change after adjustments for clinical characteristics.

The association of postload glucose with birth weight (P = 0.03) and the risk of an LGA baby (P = 0.09) was weaker and linear.

Thus in conclusion both low and high fasting glucose values at 22-30 weeks of gestation are associated with increased risk of an LGA newborn.

The researchers suggested that the excess risk related to low glucose reflects the increased use of nutrients by LGA fetuses that also affect the mothers' fasting glucose.

Source: Diabetes Care 2009

Cat: Cardiovascular diabets

Prognostic value of clinical parameters, rest and stress echocardiographic data in diabetic patients with known or suspected CAD

Des: Presence of viability and severe ischemia during DSE are independently associated with higher occurrence of hard cardiac events, in the study population

Research has shown that CAD is the main cause of morbidity and mortality in diabetic patients. Thus there is a need to determine reliable clinical parameters to stratify cardiovascular risk in these patients.

Addressing this issue, Innocenti F and colleagues assessed the prognostic value of clinical parameters, rest and stress echocardiographic data in diabetic patients, with known or suspected CAD.

The study population comprised of 322 type 2 diabetic patients, who underwent dobutamine stress echocardiography (DSE) for known or suspected CAD. For prognostic assessment, end-points were all-cause mortality and hard cardiac events (cardiac death and non fatal myocardial infarction).

The results of the study showed that -

During DSE, viability and inducible ischemia developed in 65 (20%) and 192 (60%) subjects, respectively.

A severe ischemia (an asynergic area including more than 40% of all segments combined with a rate pressure product < 17,000) appeared in 88 (27%).

At univariate analysis, the presence of a diabetic treatment or microvascular diabetic complications didn't influence prognosis, while a longer diabetes duration was associated with a higher all-cause mortality.

At multivariate analysis, an advanced age, a lower left ventricular ejection fraction and tendentially, peripheral vascular disease independently determined an increased all-cause mortality. (table 1)

Table 1

RR

CI

P

advanced age

1.108

1.039-1.182

0.002

left ventricular ejection fraction

0.956

0.919-0.994

0.025

peripheral vascular disease

2.942

0.985-8.785

0.053

New hard cardiac events occurred more frequently in presence of peripheral vascular disease, viability and severe ischemia (table 2).

Table 2

RR

CI

P

peripheral vascular disease

2.975

1.339-6.608

0.007

viability

3.427

1.400-8.390

0.007

severe ischemia

3.245

1.503-7.005

0.003

Thus in conclusion, in diabetic patients with known or suspected CAD, presence of viability and severe ischemia during DSE are independently associated with higher occurrence of hard cardiac events.

Source: Int J Cardiovasc Imaging 2010