Posts Tagged ‘pregnant’

Cut ’em off at the pass!

May 30, 2010

It’s a common scene in old Western movies: The good guys are in hot pursuit, but the bank robbers are getting away. “Quick, let’s cut ’em off at the pass!” someone shouts, and all the good guys gallop off through a shortcut. A few moments later, they’ve managed to get ahead of the evildoers!

For ten years now, Children’s Hospital of Boston has been working on cutting Hypoplastic Left Heart Syndrome (HLHS) off at the pass – by doing heart surgery while the baby is still in the mother’s womb! One of the early signs of HLHS is Fetal Aortic Stenosis; a small Aorta present before birth. (This can be detected through a Fetal Echocardiogram.) Boston Children’s has developed a procedure in which a probe is inserted into the mother and passes through the womb, into the unborn child, and enlarges the Aortic Valve. This is known as Fetal Aortic Valve Dilation.

An article in the June 2010 issue of Congenital Cardiology Today details the procedure and reports on an analysis of 70 attempts to repair the defect. 52 of the procedures (70%) were “technically successful.” If the Left Ventricle is small (and it almost always is) when the operation is done, the Ventricle will not grow. However, it will support growth of other Left Ventricle structures and HLHS can usually be avoided. Aortic regurgitation (backward blood flow through the Aortic Valve) happened in about 40% of the cases. And unfortunately, death occurred 13% of the time.

But the good news is we are starting to be able to fight a severe Congenital Heart Defect before the child is even born – and stopping a severe Congenital Heart Defect almost before it starts!

There’s a SQUID in Wisconsin!

April 7, 2010

You may remember an article that appeared on the Funky Heart! blog in February that highlighted the SQUID, which stands for Superconducting QUantum Interference Device. A SQUID is a super sensitive magnetometer that is able to detect magnetic fields and determine their strength. SQUIDs could have medical applications, but are rarely used because they are much too strong. For a squid to be effective it has to be shielded from all the sources of metal around it; and how much metal is in your average hospital? The SQUID highlighted earlier had better shielding and an easier control system.

There are very few SQUID units in hospitals today, and the ones that exist are being used for adult brain scan. But there is one unit dedicated to the study of fetal hearts, located at the University of Wisconsin-Madison.

Dr. Janette Strasburger supervises the patients during the procedure, which is painless and non invasive. The result is an hour long continuous recording of the baby’s heart rhythm and “the closest thing there is to a cardiac intensive care unit for fetuses,” Dr. Strasburger says.

Needless to say, the unit is much too big to be portable and patients have to travel to Wisconsin. That could be changing, as a portable unit is currently under construction.

Importance of Fetal Echocardiograms

April 5, 2010

There is a new report out concerning Fetal Echocardiography. Printed in two parts, it appears in the February 2010 and March 2010 issues of the newsletter Congenital Cardiology Today.

The first part of the report is mainly a synopsis of how a Fetal Echocardiogram should be done and who should do it. While a non-fetal echocardiographer will know how to obtain a four-chamber view of the fetal heart, the slightest hint of a problem should trigger a Fetal Echocardiogram. Detecting a heart problem, should one exist, depends on the time of the Fetal Echo (18-22 weeks is the best time) and the experience of the echocardiographer. And when a child has a heart problem diagnosed prenatally, their chance of survival increases 50%.

In the second part of the report (Fetal Echocardiography II: Congenital Heart Defects and Management; March 2010 issue of Congenital Cardiology Today, p. 3) the author contends “The prevalence of congenital heart malformations is higher than previously thought and is about 3-4 per 100 live births.” That’s quite the contention, and the author cites a 2008 study titled Prevalence of undiagnosed congenital cardiac defects in older children as proof. The authors of the 2008 study only used a pool of 143 children, which is pretty small. The smaller the study pool, the easier it is to obtain inaccurate results. Another study used a pool of 19,502 subjects and obtained results closer to the generally accepted ration: 8.8 children out of every 1000 are born with a Congenital Heart Defect. Both article abstracts are online; click the links and decide for yourself which study is more likely to be correct.

Despite my misgivings about the number of children born with a CHD, the report emphasizes the fact that when a standard sonogram raises doubts about the heart of the fetus, a Fetal Echocardiogram is highly recommended.

Swine Flu Update: November 4

November 4, 2009

I was able to get my H1N1 flu shot last Saturday! My State Health Department has a hotline for information on the H1N1 vaccine; since I am in a high priority group I called every few days to check on the availability. I think I got to be on a first name basis with most of their phone staff. But last Tuesday, instead of telling me the usual “Check back in a few days,” the operator asked if I would like to make an appointment to receive the vaccine! I took the earliest time available! Check your State Health Department’s website and see if they list an information line for the H1N1 vaccine and start calling!

Here’s a startling and sobering fact that you need to know: So far, 1 out of every 25 pregnant women who has contracted H1N1 has died. Take a breath, back up, and read that statement again. Read it until it has been hammered into your brain. Click the link and read the article that backs up that statement. Now, start making plans to get your H1N1 shot.

In regard the above statistic, exactly how deadly is H1N1? No one is sure. The standard measure of disease lethality is the Case Fatality Report, or CFR. Getting the CFR of H1N1 is simple math: Divide the number of people who died from H1N1 by the total number of people who contracted H1N1.

No matter what, the CFR is going to be wrong. There are going to be cases that go undiagnosed. Some people will wake up feeling miserable, realize they probably have the flu, and lock themselves away until it passes. Doctors make mistakes, and the rapid results test for H1N1 is only about 60% accurate. But the best that we can tell, H1N1 has a CFR of 0.5% for all reported cases. Regular Seasonal Flu CFR is usually about 0.1%. Both numbers are very small, but you can truthfully say that H1N1 is five times deadlier than the Seasonal Flu.

In other news, the United States has emptied its reserves of Children’s Tamiflu. Don’t worry, more is coming, and Adult Tamiflu can be “cut” to the correct dosage for children.  But that is one of those “Don’t try this at home!” activities, you don’t know what you are doing. Ask your local Pharmacist for guidance.

The Ukraine has banned public gatherings in an effort to control the spread of H1N1, since 67 people have died of “the flu”. This flu is not specifically identified but H1N1 is the most virulent illness out there right now. Ukrainian President Viktor Yushchenko addressed the nation about the flu situation – and placed all the blame for being unprepared squarely on his Prime Minister:

My request of May to the Prime Minister to allocate funds to establish a lab, to “arm” us in the situation, when the world is smitten by the epidemic of this flu, to date has not been answered.

Oh, boy.

There is also a looming crisis in Canada. The Providence of Alberta – in fact, all of Canada – was planning for a ho-hum, wait and see response by the public to the vaccine. Then three children died of H1N1 and there was a huge rush of people ready to be vaccinated. Still, things were under control until the manufacturer informed the Government of Alberta about vaccine shortages the day before the drug was needed. Clinics were suspended and a carefully crafted vaccination plan thrown into confusion. Nobody knows exactly what is going on and the opposition is calling for the Health Minister’s head. It’s becoming a political issue rather than a Public Health issue, and that’s dangerous. Meanwhile, a prominent Swedish politician has died from H1N1. North Korea claims not to have any cases of the Swine Flu. The South Korean government believes them – the average North Korean is undernourished and more susceptible to any kind of illness.  NK is probably taking drastic steps to make sure H1N1 can’t run free in their country.

Again, I have received my H1N1 vaccine, and I recommend you do the same.

Swine Flu Update: October 10

October 9, 2009

The H1N1 Swine Flu Vaccine is starting to be distributed nationwide, and just in time, it seems. Pregnant women have been hit especially hard by this bug and they are one of the priority groups that the Centers for Disease Control (CDC) recommends receive the vaccine as soon as possible. Children are also being hit hard – 19 have died this week.

Do you have the Swine Flu? Microsoft and Emory University have teamed up to create an online Flu Quiz – answer a series of questions, and your computer will compare your answers to a list of known symptoms and then inform you of the possibility that you have the flu. I answered the questions last night and the computerized doctor told me I was OK! But if someone in your home does have the Flu, here is the CDC’s informational guide for taking care of them while hopefully avoiding catching it yourself.  (If you live with someone who has the Flu and you are in a high risk group, you need to stay six feet away from the patient. Sounds like a good time to hire a Home Health Nurse.)

There have been questions raised about the safety of the vaccine, and here is the CDC’s web page addressing those issues. Also, there has been no link shown between vaccine and Autism. There was a research report from England published 10 years ago that seemingly linked the Mumps, Measles, and Rubella (MMR) vaccine with increased occurrences of Autism; but further research call those results into question. Most of the authors of that original research have since said that their research didn’t seem to hold up.

I can’t speak for anyone else, but I have taken the vaccinations that have been recommended to me over the years, and there have been no side effects other than occasional soreness at the injection site. And with my heart defect, I feel that I would have been more suceptable to any adverse reaction.

How Moms could help reduce Heart Defects!

May 15, 2009

There is new research from Canada that is showing a lot of potential:  Folic Acid, a form of Vitamin B9, could be a factor in lowering the occurrences of severe heart defects.

Earlier research links Folic Acid to lower occurrences of Spina Bifida and may lower the chances of premature birth, but new studies have shown another possible benefit of Folic Acid.  Researchers in the Province of Quebec studied the rate of serious heart defect births from 1989 to 1998, and again from 1998 to 2005. (In 1998, Quebec mandated that Folic Acid be added to grain products such as pasta and bread).

From 1989 to 1998, the number of children born with serious heart defects in Quebec averaged 1.64 per 1000 children born. While that seems to be lower than the United States figure I usually quote – 8 out of 1000 children are born with a heart defect – it’s different. The Canadian study is tracking serious heart defects, the US number is the total number of children born with a heart defect of any kind. Serious heart defects are usually defined as any of the defects that cause Cyanosis.

In the period before Folic Acid additives was mandated for grain products, the Canadians found an average of 1.64 children out of 1000 were born with a serious heart defect. After the introduction of Folic Acid, the rate of serious heart defects dropped – from 1.64 to 1.47 children out of 1000!

And while the link hasn’t been proven, there is a lot of evidence to show that it is there. The decrease in serious heart defects began to occur at about the same time as a higher level of Folic Acid was introduced into the diet. And the decrease occurred in spite of the fact that more women were overweight when they gave birth and they were having children later in life, both factors that usually increase the chances of heart defects.

While there is no guarantee that any medical condition can be avoided, it makes sense to do everything possible to tip the odds in your child’s favor.  So ask your personal physician his/her opinion about taking Folic Acid during your pregnancy.

Your friend,

“My mom has a funky heart!”

January 9, 2009

Laurie over at A Chronic Dose has an excellent post about having a baby when you are chronically ill. Laurie doesn’t mention Congenital Heart Defects specifically, but a lot of her information can help prospective parents make an informed decision.  It would pay for both partners to read this link, since raising a family requires so much teamwork… especially when one parent could become incapacitated at any time.

The good news is that a woman with a Congenital Heart Defect can have a child! Dr. Carole Warnes of the Mayo Clinic presented a paper and gave an interview concerning Adult CHD pregnancy. But you shouldn’t just throw caution to the wind. An expectant mother with a Heart Defect needs to be monitored by an Adult Congenital Heart Defect Cardiologist or a high risk OB/GYN, and possibly both. There are defects in which pregnancy is defiantly not recommended, and drugs or drug dosages may need to be altered. This is not a do-it-yourself project!

So… where can you find an Adult Congenital Heart Defect Cardiologist? There’s not one on every corner, I hate to say. If you’re an adult living with a Congenital Heart Defect, you really need to consider joining the Adult Congenital Heart Association (ACHA). Membership is free to Adult CHD Survivors, and one of the benefits of membership is access to the Clinic Directory. This directory lists Adult Congenital Care programs across the country; some of them have a high risk OB/GYN on staff, or they can recommend someone.