CARDIOVASCULAR JOURNAL OF AFRICA • Vol 24, No 1, January/February 2013
AFRICA
129
tions, high pulmonary artery pressures, poor respiratory reserve
and on high inotropic support is a routine practice. Mandatory elec-
tive ventilation also has its risks and complications such as sudden
tube displacement, mucus plug blockages, atelectasis, infection and
bleeding due to tracheal trauma. Sudden deaths in the intensive care
unit (ICU) mostly occur in patients on ventilators as a result of one
of the complications mentioned above, but are under-reported. Fast
tracking emerged as one of the major advances in the recent era but
has limitations, requiring an extremely vigilant and expert intensive
care team which most cardiac surgical ICUs lack in India. We have
evolved a strategy employing routine use of continuous positive
airway pressure (CPAP) therapy in all elective early weaning from
mechanical ventilation and instituting CPAP mask ventilation with
secured airway preserving normal swallowing, speech and feeding.
Exclusion criteria include renal failure, low cardiac output state or
state of confusion or non-co-operation.
Material and methods
: Between January 2010 and April 2012,
CPAP mask ventilation was prospectively used in 125 patients
who had high respiratory or cardiac risk factors. All patients were
counselled in the pre-operative period and were given a short trial
of CPAP ventilation a day prior to their surgery. Analysis included
retrospectively: operated age-, sex-, disease- and NYHA-matched
population of 135 patients operated earlier. Patient’s co-operation and
absence of chest infection were mandatory requirements.
Results
: Incidence of lung atelectasis, retained secretions, poor arte-
rial blood gases (ABGs) were significantly less in the CPAP ventila-
tion group. Cardiac arrhythmia (AF) did not differ between groups.
Only 1 patient required re-intubation in the CPAP group except1,
who had cardiac arrest as a result of acute severe mitral insufficiency
after a failed mitral repair. Two patients in the non-CPAP group
required re-intubation. Total ICU and hospital stay was significantly
less in the CPAP group, who also complained of less postoperative
pain and less need for physiotherapy and coughing. More importantly
there was significant cost reduction in the CPAP group. Detailed data
and group analysis will be presented.
1631: FREQUENCY OF MISCARRIAGE, STILLBIRTH AND
PREGNANCY TERMINATION IN WOMEN WITH CONGEN-
ITAL HEART DEFECTS IN GERMANY, HUNGARY AND
JAPAN
Marc-Andre Kurten
1
, Andras Szatmari
2
, Nicole Nagdyman
3
, Eva
Niggemeyer
1
, Koichiro Niwa
4
, Brigitte Peters
5
, Thomas Pickardt
1
,
Karl-Theodor M Schneider
6
, Harald Kaemmerer
7
, Ulrike MM Bauer
1
1
Registry and Competence Network for Congenital Heart Defects,
Berlin, Germany
2
Hungarian Center for Pediatric Cardiology, Hungary
3
Department of Pediatric Cardiology, German Heart Institute Berlin,
Germany
4
Chiba Cardiovascular Center, Japan
5
Department of Biometry, Otto von Guericke University, Magdeburg,
Germany
6
Department for Perinatal Medicine and Perinatal Physiology, TU
Munich, Germany
7
Department of Congenital Heart Defects, German Heart Center
Munich, Germany
Background
: The 2011 ‘ESC Guidelines on the management of
cardiovascular diseases during pregnancy’ define maternal predictors
for neonatal events (preterm birth, small for gestational age, respira-
tory distress syndrome, cerebral haemorrhage, foetal/neonatal death)
in pregnancies in women with heart disease. It is unknown whether
these predictors also lead to an increased number of miscarriages,
stillbirths and terminations of pregnancy (TOP), particularly regard-
ing patients with congenital heart defects (CHD). In the general
population, miscarriages and stillbirths occur in 15–20%. In the
participating countries, stillbirth occurs in below 0.5% of all preg-
nancies.
Material and methods:
In a multicentre cross-sectional question-
naire-based study, 634 women with CHD (Germany 61%, Hungary
24%, Japan 15%) were surveyed over a period of 12 months concern-
ing courses of pregnancy. Of 634 women, 309 had been pregnant at
least once (578 pregnancies). Patients were grouped into those with
and those without existing maternal predictors for neonatal events.
The predictors were NYHA classification greater than class II or
cyanosis, maternal left heart obstruction, smoking during pregnancy,
multiple gestation, use of oral anticoagulants during pregnancy, and
mechanical valve prosthesis. The outcomes were miscarriage/still-
birth and TOP (miscarriages and stillbirths were grouped together).
Results
: In 75 women with predictors, a total of 141 pregnancies
occurred (group 1, 24%). In 234 women without predictors, a total
of 437 pregnancies occurred (group 2, 76%). There were no signifi-
cant differences between the participating countries. There were 27
(19.1%) miscarriages/stillbirths in group 1 and 70 (16.0%) in group
2 (
p
=
0.532), and 22 (15.6%) and 24 (5.5%) TOP respectively (
p
=
0.002). The combined figures were 49 (34.8%) and 94 (21.5%)
respectively (
p
=
0.042).
Conclusion
: Underlying maternal predictors for neonatal complica-
tions do not lead to a significantly higher number of miscarriages or
stillbirths. However, TOP occurred significantly more frequently in
this group. In the presence of maternal predictors for neonatal events
pregnancies in women with CHD are less likely to be successful.
1641: EVALUATION OF CONTRACEPTIVE METHODS
IN WOMEN WITH CONGENITAL HEART DEFECTS IN
GERMANY, HUNGARY AND JAPAN
Marc-Andre Kurten
1
, Andras Szatmari
2
, Nicole Nagdyman
3
, Eva
Niggemeyer
1
, Koichiro Niwa
4
, Brigitte Peters
5
, Thomas Pickardt
1
,
Karl-Theodor M Schneider
6
, Ulrike MM Bauer
1
, Harald Kaemmerer
7
1
Registry and Competence Network for Congenital Heart Defects,
Berlin, Germany
2
Hungarian Center for Pediatric Cardiology, Hungary
3
Department of Pediatric Cardiology, German Heart Institute Berlin,
Germany
4
Chiba Cardiovascular Center, Japan
5
Department of Biometry, Otto von Guericke University, Magdeburg,
Germany
6
Department for Perinatal Medicine and Perinatal Physiology, TU
Munich, Germany
7
Department of Congenital Heart Defects, German
Heart Center Munich, Germany
Background
: The 2011 ‘ESC Guidelines on the management of
cardiovascular diseases during pregnancy’ recommend that mater-
nal risk assessment for women with heart diseases is carried out
according to the modified World Health Organization (WHO) risk
classification. Particularly for women with congenital heart defects
(CHD) who are at a higher pregnancy-related risk for cardiovascular
complications or in whom pregnancy is contraindicated, early and
effective contraception is necessary.
Material and methods:
In a multicentre cross-sectional question-
naire-based study, 634 women with CHD (Germany 61%, Hungary
24%, Japan 15%) were surveyed over a period of 12 months
concerning contraception. Median age was 30 years. According to
the modified WHO classification of maternal cardiovascular risk,
patients were grouped into three risk groups (low, medium and high/
pregnancy contraindicated). The contraceptive methods (CM) used
by each group were determined. In this study CM with a Pearl index
≤
2 (at ideal use) was classified as ‘safe’.
Results:
In all three risk groups almost one-third of the women was
using a CM classified as unsafe (low-risk 85 (27.9%); medium-risk
64 (30.5%); high-risk 20 (29.9%)). In 29% of all cases an unsafe CM
was used. There was no significant difference between the participat-
ing countries.
Conclusion
: Alarmingly, almost one-third of the women with CHD
and increased pregnancy-related risk of cardiovascular complica-
tions or contraindication for pregnancy were using a CM deemed as
unsafe. More efficient education regarding contraception in women
with CHD is necessary.
