1: J Gynecol Obstet Biol Reprod (Paris). 2004 Oct;33(6 Pt 1):497-505.
[Factors associated with fecal incontinence after childbirth: prospective study
in 525 women.]
[Article in French]
Roman H, Robillard PY, Payet E, El Amrani R, Verspyck E, Marpeau L, Barau G.
Service de Gynecologie et Obstetrique, Groupe Hospitalier Sud Reunion, 97448
Saint-Pierre, Ile de la Reunion.
OBJECTIVE: To determine the prevalence of fecal incontinence after childbirth
and to identify the risk factors. METHODS: This was a prospective observational
study with a consecutive inclusion of 525 women who delivered over a three
months period. Women were questioned about their fecal continence four days and
six weeks after delivery. RESULTS: The incidence of fecal incontinence four days
and six weeks after childbirth was respectively 8.8% and 3.3%. The risk factors
for fecal incontinence at 4 days after childbirth were instrumental delivery by
forceps (adjusted odds ratio 8.64, 95% confidence interval 3.55-21.0, p<0.001)
and unassisted delivery at home (adjusted OR 8.06, 95% CI 1.30-50.0, p=0.025).
Independent risk factors for the presence of fecal incontinence 6 weeks later
were: instrumental forceps delivery (adjusted OR 10.8, 95% CI 2.82-41.3,
p=0.001), unassisted delivery at home (adjusted OR 50.0, 95% CI 3.09-802,
p=0.006), bi-parietal diameter of the newborn>93mm (adjusted OR 4.56, 95% CI
1.46-14.1, p=0.009) and maternal age>30 years (adjusted OR 4.60, 95% CI
1.11-19.1, p=0.036). CONCLUSION: Fecal incontinence is common after childbirth
and its prevalence is predominantly associated with instrumental delivery,
unassisted delivery at home, bi-parietal diameter of the newborn and maternal
age.
PMID: 15567965 [PubMed - in process]
2: Ann Pathol. 2004 Sep;24(4):312-8.
[Cytokeratins 7 and 20 immunohistochemistry in ampullary carcinomas.]
[Article in French]
Le Pessot F, Ranty ML, Hellot MF, Lemoine F, Teniere P, Testart J, Metayer J.
Service d'Anatomie Pathologique.
Ampullary carcinomas (AC) account for 33% of all surgically operable
pancreatoduodenal tumors. The 5-year relative survival rate is 50% and tumoral
stage is the main prognostic factor. However, among the three AC histological
subtypes (intestinal, pancreatobiliary and mixed), a favorable prognostic has
been reported for the intestinal subtype. BACKGROUND:: The aims of this study
were to determine the prognostic impact of AC histologic subtype and of
cytokeratins (CK) 7 and 20 immunostaining profile in these tumors. PATIENTS AND
METHODS:: Clinical data of 54 AC were obtained retrospectively. Macroscopic and
histologic documents were reviewed and immunostainings for CK7 and CK20 were
performed. RESULTS:: The classification of tumors, according to histological
subtype, was: intestinal 26%, pancreatobiliary 65% and mixed 9%. No correlation
was found between histological subtype and tumor stage. The 5-year survival rate
varied from 100% for intestinal subtype to 35% for pancreatobiliary subtype. A
strong correlation (p<0.0001) was found between histological subtype and
CK7/CK20 immunostaining profile. The 5-year survival rate varied from 100% for
CK7-/CK20 + AC to 40% for CK7 +/CK20- AC. CONCLUSION: In our study, the
intestinal histological subtype had a favorable prognostic value. CK7/CK20
immunostaining profile was helpful for the identification of histological
subtype and appears to provide additional prognostic information.
PMID: 15567946 [PubMed - in process]
3: Lancet. 2004 Nov 27;364(9449):1939-44.
Prophylactic ibuprofen versus placebo in very premature infants: a randomised,
double-blind, placebo-controlled trial.
Gournay V, Roze JC, Kuster A, Daoud P, Cambonie G, Hascoet JM, Chamboux C, Blanc
T, Fichtner C, Savagner C, Gouyon JB, Flurin V, Thiriez G.
Service de Reanimation Pediatrique et Neonatale, Hopital de la Mere et de
l'Enfant, Centre Hospitalier Universitaire (CHU) de Nantes, Quai Moncousu, 44000
Nantes, France. veronique.gournay@chu-nantes.fr
BACKGROUND: Patent ductus arteriosus is a common complication of prematurity
that frequently requires surgical or medical treatment. The benefit of
prophylactic treatment by indometacin, a cyclo-oxygenase inhibitor, remains
uncertain compared with curative treatment. This benefit could be improved with
ibuprofen, another cyclo-oxygenase inhibitor with fewer adverse effects than
indometacin on renal, mesenteric, and cerebral perfusion. We aimed to compare
prophylactic and curative ibuprofen in the treatment of this abnormality in very
premature infants. METHODS: We did a randomised controlled trial in infants
younger than 28 weeks of gestation, who were randomly assigned to receive either
three doses of ibuprofen or placebo within 6 h of birth. After day 3,
symptomatic patent ductus arteriosus was treated first by open curative
ibuprofen, then back-up indometacin, surgery, or both. The primary endpoint was
need for surgical ligation. Analysis was per protocol. FINDINGS: The study was
stopped prematurely after 135 enrollments because of three cases of severe
pulmonary hypertension in the prophylactic group. 65 infants received
prophylactic ibuprofen, and 66 received placebo. Prophylaxis reduced the need
for surgical ligation from six (9%) to zero (p=0.03), and decreased the rate of
severe intraventricular haemorrhage from 15 (23%) to seven (11%) (p=0.10).
However, survival was not improved (47 [71%] placebo vs 47 [72%] treatment,
p=1.00), because of high frequency of adverse respiratory, renal, and digestive
events. INTERPRETATION: In premature infants, prophylactic ibuprofen reduces the
need for surgical ligation of patent ductus arteriosus, but does not reduce
mortality or morbidity. Therefore, it should not be preferred to early curative
ibuprofen.
PMID: 15567009 [PubMed - in process]
4: Transfus Clin Biol. 2004 Oct;11(4):199-204.
[Article in French]
Josset V, Chamouni P, Merle V, Tavolacci MP, Froment L, Daubert H, Ladner J,
Czernichow P.
Departement d'epidemiologie et de sante publique, CHU-Hopitaux de Rouen, 1, rue
de Germont, 76031 Rouen cedex, France; Reseau de recherche sur le systeme de
soins, UFR de Rouen, 1, rue de Germont, 76031 Rouen cedex, France.
The aim of this study was to estimate short term survival rate after blood
transfusion according to various criteria. Patients and methods. - Patients
admitted and transfused from January, 1 until June, 30 1996 at Rouen university
hospital were retrospectively included, and their status (alive or dead) was
determined. The characteristics of patients admitted and transfused were
compared to the overall population of impatients. Independent factors associated
with mortality six months after blood transfusion were evaluated using Cox
model. Results. - During the study period, 1887 patients were transfused. These
patients were older, more often admitted in surgical or in intensive care units,
and had a longer duration of stay, than the overall inpatients population. The
survival rate at six months in transfused patients was 76.1%. Mortality rate at
six months was independently higher in patients aged 75 and older, in men, in
patients admitted in intensive care units, or transfused with homologous
fresh-frozen plasma or packed platelet blood cells. Mortality rate was lower in
patients who underwent a surgical procedure, in children under 16, and in
patients whose stay was classified in "Circulatory system disorders",
"Musculoskeletal system and connective tissues disorders or trauma", or
"Injuries, allergy or poisoning". Conclusion. - In this study implemented in a
teaching hospital inpatients receiving blood transfusion, the survival was
mainly associated with the severity and characteristics of the diseases
requiring transfusion.
PMID: 15564101 [PubMed - as supplied by publisher]
5: Transfus Clin Biol. 2004 Oct;11(4):186-191.
[Article in French]
Josset V, Chamouni P, Tavolacci MP, Merle V, Delbos V, Froment L, Ladner J,
Ounnoughene N, Czernichow P.
Departement d'epidemiologie et de sante publique, Unite d'information medicale,
CHU de Rouen, 1, rue de Germont, 76031 Rouen cedex, France; Reseau de recherche
sur le systeme de soins. UFR de Rouen, 1, rue de Germont, 76031 Rouen cedex,
France.
Efficiency of a viral hepatitis C screening strategy before and after blood
transfusion has to be evaluated. Methods. - Four screening strategies were
virtually applied to the population of transfused patients at Rouen University
Hospital during 1996 and then compared : the first without any systematic HCV
screening test; the second with systematic testing both before and 3 months
after transfusion; the third with systematic testing both before and 6 months
after transfusion ; the last defined as systematic testing before transfusion
only. The efficacy (i.e. number of positive tests), the efficiency (i.e. average
cost per positive test) and the marginal costs of moving from a strategy to
another one were assessed using decision analysis. Results. - The efficacy of
systematic screening test before transfusion only (361 per positive test),
systematic testing both before and three months after (523 per positive test) or
six months after (488 per positive test) transfusion was similar, but the
efficacy of the strategy without any systematic screening test (385 per positive
test) was lower. The systematization of screening test both before, and three
months, or 6 months after transfusion lead to a marginal cost of 619 , and 559
per positive test respectively. The systematization of testing before
transfusion only lead to a marginal cost of 343 per positive test. Adding
systematic testing after transfusion lead to a marginal cost of 5824 per
positive test. Conclusion. - Systematic screening tests before transfusion only
can be considered as the most efficient strategy.
PMID: 15564099 [PubMed - as supplied by publisher]
6: Transfus Apheresis Sci. 2004 Dec;31(3):191-197.
Transient anti rhesus alloantibody produced by graft after non-myeloablative
allogeneic stem cell transplant.
Contentin N, Lenain P, Chamouni P, Hau F, Bastit D, Buchonnet G, Tilly H.
Department of Hematology, Centre Henri Becquerel, 1, rue d'Amiens, 76038 Rouen
Cedex, France.
Background: We report the case of a patient who received an allogeneic
transplant with peripheral blood compatible ABO, Rhesus mismatched progenitor
cells and who developed an asymptomatic transient anti Rhesus alloimmunisation.
Case report: A 56-year-old man with renal cell carcinoma received a
non-myeloablative allogeneic PBPC ABO compatible graft from his HLA-identical
brother. Graft-versus-host disease prophylaxis consisted of cyclosporine alone.
On day+59, prior to any transfusion, a positive direct antiglobulin test (IgG++,
C3d-) was detected. The indirect antiglobulin test (IAT) was considered
doubtful, and IAT identification revealed the presence of an active anti Rhesus
antibody (anti D specificity) in the patient's serum. This immunisation had no
clinical consequence, with no acute hemolytic episode. Further monitoring showed
negative antibody screening tests on day+78. Conclusion: To our knowledge this
is the first reported case of transient anti Rh (D) allo-immunisation after
non-myeloablative allogeneic peripheral blood progenitor cell (PBPC) transplant.
The period of occurrence and the specificity of this antibody strongly suggest a
donor cell origin.
PMID: 15556466 [PubMed - as supplied by publisher]
7: Soins. 2004 Oct;(689):54.
[In Process Citation]
[Article in French]
Regent L.
Ifsi Chu Rouen.
PMID: 15551649 [PubMed - in process]
8: Rev Mal Respir. 2004 Sep;21(4 Pt 1):856-9.
[Evidence based respiratory medicine: 2nd update workshop of the SPLF]
[Article in French]
Cuvelier A, Muir JF, Roche N.
Service de Pneumologie et Soins Intensifs, CHU de Rouen, Hopital Bois Guillaume,
France. Antoine.cuvelier@chu-rouen.fr
PMID: 15551506 [PubMed - in process]
9: Cancer Res. 2004 Nov 15;64(22):8143-7.
Significant contribution of germline BRCA2 rearrangements in male breast cancer
families.
Tournier I, Paillerets BB, Sobol H, Stoppa-Lyonnet D, Lidereau R, Barrois M,
Mazoyer S, Coulet F, Hardouin A, Chompret A, Lortholary A, Chappuis P, Bourdon
V, Bonadona V, Maugard C, Gilbert B, Nogues C, Frebourg T, Tosi M.
Institut National de la Sante et de la Recherche Medicale (INSERM) U614, Faculty
of Medicine, IFRMP, University of Rouen, Rouen, France.
Although screening for large deletions or duplications of the BRCA1 gene is
becoming a routine component of the molecular diagnosis of familial breast
cancer, little is known about the occurrence of such rearrangements in the BRCA2
gene. Because of the high frequency of BRCA2 mutations in breast cancer families
with at least one case of male breast cancer, we selected a cohort of 39 such
families, tested negative for mutations in the coding regions of BRCA1 and
BRCA2, and developed an assay for BRCA2 rearrangements, based on quantitative
multiplex PCR of short fluorescent fragments (QMPSF). We found three
rearrangements: (1) a deletion of exons 12 and 13; (2) a duplication of exons 1
and 2; and (3) a complete deletion of BRCA2. We determined the boundaries of the
deletion of exons 12 and 13, showing that it resulted from an unequal
recombination between Alu sequences. We mapped the complete BRCA2 deletion,
which extends over at least 298 kb and showed that it does not affect APRIN/AS3,
previously characterized as a tumor suppressor gene, but it comprises several
loci corresponding to proven or putative transcripts of unknown functional
significance. These data suggest that screening for BRCA2 rearrangements should
be done, especially in male breast cancer families tested negative for BRCA1 and
BRCA2 mutations.
PMID: 15548676 [PubMed - in process]
10: Eur J Neurosci. 2004 Nov;20(10):2629-2638.
Involvement of corticostriatal glutamatergic terminals in striatal dopamine
release elicited by stimulation of delta-opioid receptors.
Billet F, Dourmap N, Costentin J.
Unite de Neuropsychopharmacologie Experimentale, U.M.R. 6036 C.N.R.S.,
I.F.R.M.P. no. 23, Faculte de Medecine et de Pharmacie de Rouen, 22 Boulevard
Gambetta, 76183 Rouen Cedex 01, France.
Abstract We have previously shown that striatal dopamine release induced locally
by a delta-opioid receptor agonist was totally inhibited by a glutamate
N-methyl-d-aspartate receptor antagonist, indicating the involvement of
glutamatergic receptors in this effect. The aim of the present study was to
specify this mechanism. Firstly, we investigated the effect of
[D-Pen(2),D-Pen(5)]-enkephalin (DPDPE) on glutamate release in rats by
intrastriatal microdialysis. The infusion of DPDPE (10 microm) enhanced the
glutamate content in dialysate by approximately 34%, an effect which did not
appear to result from inhibition of glutamate uptake. We then considered the
consequences of a unilateral thermocoagulation of the frontal cortex on either
glutamate or dopamine release induced by stimulation of delta-opioid receptors 2
days later. This lesion, which decreased the glutamate content in ipsilateral
striatum by approximately 30%, totally prevented the increase in dialysate
levels of glutamate induced by DPDPE. Moreover, whereas DPDPE (10 microm) was
found to increase the striatal dopamine release in intact animals by
approximately 59%, this effect was also completely suppressed by the cortical
lesion. Finally, we studied the effect of the lesion on the [(3)H]-DPDPE binding
to striatal membranes prepared from the whole striatum. In the ipsilateral
striatum a significant decrease in this [(3)H]-DPDPE binding (by approximately
18%) was found 2 days after the lesion. Our results indicate that the increase
in striatal dopamine release induced by DPDPE probably depends on glutamate
release from corticostriatal glutamatergic afferents in response to the
stimulation of delta-opioid receptors located on terminals of these neurons.
PMID: 15548206 [PubMed - as supplied by publisher]
11: Lupus. 2004;13(10):800-4.
Autoantibodies recognizing the 27 carboxy-terminal amino acids of calpastatin
are associated with secondary Sjögren syndrome in systemic lupus erythematosus.
Salle V, Vittecoq O, Jouen-Beades F, Menard JF, Ducroix JP, Godin M, Le Loet X,
Tron F.
Inserm U519 and Institut Federatif de Recherche Multidisciplinaire sur les
Peptides (IFR 23), Faculte de Medecine et de Pharmacie, Rouen, France.
salle.valery@chu-amiens.fr
The objective of this study was to determine in systemic lupus erythematosus
(SLE) the prevalence and clinical significance of anticalpastatin antibodies
(ACAST), an autoantibody population previously detected in sera from patients
with various connective tissue diseases. Eighty-four patients with SLE (mean
age: 30 years at diagnosis, females 77) that fulfilled ACR criteria were
included in the study retrospectively. Several clinical and biological data were
collected. ACAST were detected by a solid-phase enzyme linked immunosorbent
assay (ELISA) using as antigen a synthetic peptide corresponding to the 27
C-terminal amino acids of calpastatin (CAST-C27). The prevalence of ACAST-C27
was 13% (11/84) in SLE patients. No correlation was found between the presence
of ACAST-C27 and clinical manifestations such as thrombosis and vasculitis.
Furthermore, no correlation was observed with the presence ofantiphospholipid
antibodies (APL). However, we found a statistically significant association
between the presence of ACAST-C27 and that of secondary Sjogren syndrome (P =
0.01). The conclusion is ACAST-C27 are not associated with thrombosis in SLE
patients. The association observed between ACAST-C27 and secondary Sjogren
syndrome suggests that ACAST-C27 might be useful in discriminating a clinical
subgroup of SLE patients.
PMID: 15540513 [PubMed - in process]
12: Rev Pneumol Clin. 2004 Nov;60(5 Pt 2):104-9.
[The place for therapeutic intensification in small cell lung cancer.]
[Article in French]
Corne F, Thiberville L.
Clinique Pneumologique, Hopital Charles-Nicolle, CHU, 76000 Rouen.
Therapeutic intensification of small cell lung cancer (SCLC) relies on either
the simultaneous and repeated administration of a greater number of drugs
without cross-resistance, or to the use of classical combinations with greater
intensity, either by increasing the doses in each cycle or by reducing the
intervals between cycles. The authors review the trials concerning disseminated
SCLC: eight randomised studies have compared a standard regimen with an
intensified regimen: only one has demonstrated a benefit in terms of survival
with the intensified regimen. They will then discuss the problem of
intensification of the chemotherapy in the particular case of localised SCLC,
which requires the combination of chemotherapy and thoracic radiotherapy: two
studies were in favour of the intensified regimen. Lastly, intensification,
associating massive doses of polychemotherapy with autologous bone marrow graft
or re-injection of hematopoietic stem cells, increases the response rate at the
price of a significant increase in toxicity and costs, without benefit in terms
of survival.
PMID: 15536362 [PubMed - in process]
13: Ann Cardiol Angeiol (Paris). 2004 Sep;53(5):239-44.
[Non-invasive coronary angiography by multidetector spiral computed tomography
and magnetic resonance imaging]
[Article in French]
Tron C, Dacher JN, Eltchaninoff H, Gerbaud E, Bertrand D, Cribier A.
Service de cardiologie, hopital Charles-Nicolle, 1, rue de Germont, 76000 Rouen,
France. christophe.tron@chu-rouen.fr
Coronary angiography is the reference standard to confirm the presence and
severity of coronary stenoses. Given the invasiveness of this procedure, a
noninvasive mean allowing to visualize coronary anatomy would be of obvious
clinical interest. Multidetector spiral computed tomography and magnetic
resonance imaging are new and promising techniques for noninvasive detection of
significant coronary stenoses. The purpose of this article is to review the
present knowledge on these noninvasive techniques.
PMID: 15532448 [PubMed - in process]
14: Ann Cardiol Angeiol (Paris). 2004 Sep;53(5):234-8.
[Percutaneous correction of acquired aortic stenosis and mitral insufficiency in
adults]
[Article in French]
Tron C, Eltchaninoff H, Bauer F, Agatiello C, Sebagh L, Nercolini D, Vochelet F,
Cribier A.
Service de cardiologie, hopital Charles-Nicolle, 1, rue de Germont, 76000 Rouen,
France. christophe.tron@chu-rouen.fr
Aortic stenosis and mitral regurgitation are the most common valvular diseases
in western countries. Surgical treatment, aortic valve replacement or mitral
valve repair, is the treatment of choice. Innovative technologies could offer an
alternative therapeutic option to the patients with increased operative risk.
This article will report the early experience with these promising techniques as
presented at the High-Tech 2004 meeting.
PMID: 15532447 [PubMed - in process]
15: Soins. 2004 Sep;(688 Suppl):5.
[In Process Citation]
[Article in French]
Godin M.
Service nephrologie, CHU Rouen.
PMID: 15526820 [PubMed - in process]
16: Eur Heart J. 2004 Nov;25(21):1934-9.
Tissue Doppler imaging detects early asymptomatic myocardial abnormalities in a
dog model of Duchenne's cardiomyopathy.
Chetboul V, Escriou C, Tessier D, Richard V, Pouchelon JL, Thibault H, Lallemand
F, Thuillez C, Blot S, Derumeaux G.
INSERM E0001, Kremlin-Bicetre, France.
AIMS: Early diagnosis of Duchenne's dilated cardiomyopathy remains a challenge
for conventional echocardiography. We sought to determine whether tissue Doppler
imaging (TDI) could detect early alteration in myocardial function in a dog
model of Duchenne muscular dystrophy, i.e. the Golden Retriever Muscular
Dystrophy (GRMD). METHODS AND RESULTS: Myocardial function was assessed by TDI
in 20 dogs with normal conventional parameters of systolic function (eight
controls and 12 GRMD, 25+/-11 weeks) without knowledge of the genotype. M-mode
TDI was recorded from a short-axis view for measurement of endocardial and
epicardial velocities and myocardial velocity gradient (MVG) within the
posterior wall. Controls and GRMD dogs were comparable regarding left
ventricular fractional shortening (37+/-2 vs 42+/-3%, p=ns). Conversely, TDI
showed, in all GRMD dogs, a dramatic decrease in systolic MVG (0.8+/-0.1 vs
2.9+/-0.3 s(-1), p<0.0001) and early diastolic MVG (2.3+/-2.2 vs 10.8+/-1.1
s(-1), p<0.0001). This MVG alteration was related to a significant decrease in
endocardial velocities in GRMD whereas epicardial velocities were comparable in
the two groups. CONCLUSION: These results show that TDI is more sensitive than
conventional echocardiography in detecting pre-clinical myocardial abnormalities
before occurrence of left ventricular dilation and dysfunction. TDI should be
part of the screening techniques for the early diagnosis of cardiomyopathy.
PMID: 15522473 [PubMed - in process]
17: Regul Pept. 2004 Dec 15;123(1-3):43-9.
Pituitary adenylate cyclase-activating polypeptide inhibits caspase-3 activity
but does not protect cerebellar granule neurons against beta-amyloid
(25-35)-induced apoptosis.
Vaudry D, Cottet-Rousselle C, Basille M, Falluel-Morel A, Fournier A, Vaudry H,
Gonzalez BJ.
European Institute for Peptide Research (IFRMP 23), Laboratory of Cellular and
Molecular Neuroendocrinology, INSERM U413, UA CNRS, University of Rouen, 76821,
Mont-Saint-Aignan, France.
The beta-amyloid (Abeta) peptide Abeta25-35 provokes apoptosis of cerebellar
granule cells through activation of caspase-3 while the neuropeptide pituitary
adenylate cyclase-activating polypeptide (PACAP) promotes granule cell survival
by inhibiting caspase-3 activation through the intrinsic apoptotic pathway. The
aim of the present study was to determine whether PACAP could prevent Abeta25-35
neurotoxicity by inhibiting caspase-3 activity. A 24-h exposure of cultured
cerebellar granule cells to Abeta25-35 induced shrinkage of cell bodies, neurite
retraction and alteration of mitochondrial activity. Administration of graded
concentrations (10-80 microM) of Abeta25-35 induced a dose-related decrease of
the number of living cells, and the neurotoxic effect was highly significant
after a 24-h exposure to 80 microM Abeta25-35. Exposure of cerebellar granule
cells to Abeta25-35 markedly enhanced caspase-3 but not caspase-9 activity.
Co-incubation with 1 microM PACAP significantly reduced Abeta25-35-evoked
caspase-3 activation. In contrast, PACAP did not prevent the deleterious effects
of Abeta25-35 on mitochondrial potential and granule cell survival. Taken
together, these data suggest that caspase-3 activation is not the main pathway
activated by Abeta25-35 that leads to granule cell death. The results also
demonstrate that PACAP cannot be considered as a potent neuroprotective factor
against Abeta25-35-induced apoptosis in cerebellar granule neurons.
PMID: 15518892 [PubMed - in process]
18: Obstet Gynecol. 2004 Nov;104(5 Pt 2):1212-5.
Management of maternal cor triatriatum during pregnancy.
Sentilhes L, Verspyck E, Bauer F, Marpeau L.
Department of Obstetrics and Gynecology, Rouen University Hospital -Charles
Nicolle, Rouen, France. loicsentilhes@hotmail.com
BACKGROUND: Cor triatriatum is a rare congenital cardiac abnormality, usually
diagnosed in childhood. We describe the first case of atrial fibrillation
secondary to maternal cor triatriatum diagnosed during the first trimester of
pregnancy and its successful management until postpartum (MEDLINE [1966 to 2003]
and Embase [1988 to 2003], using MeSH terms for "cor triatriatum" and
"pregnancy"). CASE: A 31-year-old gravida 1 complained of progressive dyspnea on
exertion and palpitations, which occurred at the end of the first trimester of
the pregnancy. Atrial fibrillation was observed on electrocardiogram. A
transesophageal echocardiography examination revealed a cor triatriatum that was
responsible for the arrhythmia. beta-adrenergic blocking agents and digitalis
glycosides were used to control supraventricular arrhythmia, while
low-molecular-weight heparin was administered to prevent thromboembolic events.
Low-molecular-weight heparin was discontinued at 37 weeks of gestation, and
subcutaneous unfractionated heparin was administered instead. Pregnancy
continued a normal course until full-term vaginal delivery with epidural
anesthesia and close hemodynamic monitoring. CONCLUSION: A standard treatment
for atrial fibrillation could be effective in preventing maternal hemodynamic
complications secondary to cor triatriatum during pregnancy. Moreover, this case
illustrates the American consensus in neuraxial anesthesia and anticoagulation,
which supports the opinion that there is a limited risk associated with the use
of epidural and spinal anesthesia in the presence of subcutaneous heparin
treatment.
PMID: 15516457 [PubMed - in process]
