Anisa Chowdhury
18 statements · 1 topic
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Lisinopril is teratogenic and should be stopped in pregnancy
guideline ·
Single Ventricle / HLHS
Beta blocker was considered if LV function remained depressed on subsequent visits
clinical ·
Single Ventricle / HLHS
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Anisa's statements about Single Ventricle / HLHS 18 statements
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Pregnancy in a Fontan Patient: New Horizons in Medical and Surgical Fontan...
Quotation
So this is a case of a 21-year-old woman who was born to tricuspiddoresia, a large ventricular septal defect, detransposition of the great arteries, and a severe lung segment aortic coagation.
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The patient underwent coarctation repair and PA banding at 2 days of life via end-to-end anastomotic repair after resection of coarc segment, plus left carotid to left subclavian artery side-to-side anastomosis
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The patient underwent right modified Blalock-Thomas-Taussig shunt at 6 weeks of age, bidirectional Glenn at 6 months, and 20mm extracardiac Fontan at 4 years of age
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The Fontan fenestration spontaneously closed and patient had transcatheter coil and vascular plugging of veno-venous collaterals at approximately 10 years of age
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On 2006 catheterization, Fontan pressures were 12 mmHg and left ventricular end-diastolic pressure was 5 mmHg, both normal
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Patient was lost to follow-up from age 16 to 21 years until presenting pregnant in first trimester
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She was then lost to follow up from age 16 to 21 years of age until she presented pregnant in her first trimester, to an outside adult cardiologist.
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Patient had 3 prior miscarriages and was told to use Depo-Provera contraception but only had 1 injection in past 3-4 years
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Patient had baseline NYHA class 2-3 dyspneic symptoms (short of breath climbing one flight of stairs or walking 2 blocks) with no change during first couple trimesters of pregnancy
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She had repeatedly expressed concern about a higher peripartum mortality via vaginal delivery, and this was obtained through a variety of internet browsing readings.
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Echocardiogram showed mildly reduced left ventricular systolic function with estimated LVEF 45-50%
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Patient had mild polycythemia with hemoglobin of 17, indicative of probable intermittent desaturations likely from venous collaterals
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We deemed her a WHO class 3 risk, uh, given the uh WHO risk stratification as she is a, a complex Fontan patient, which indicates that she has a significantly elevated risk of both maternal morbidity and mortality during the peripartum period and the remainder of pregnancy.
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Patient was classified as WHO class 3 risk, indicating significantly elevated risk of both maternal morbidity and mortality during peripartum period
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Management included aspirin 162 mg daily; stronger anticoagulation not pursued given unremarkable thrombophilia profile
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