Abstract: Objective To investigate the anticoagulation effect of warfarin on pregnant women with prosthetic mechanical heart valves during the whole course of pregnancy and their fetuses. Methods Followup survey was carried out on 103 pregnant women with prosthetic mechanical heart valves treated in the Second Xiangya Hospital of Central South University from April 1998 to June 2010. Their age ranged from 19 and 38 years (26.4±3.8 years). All the 103 pregnant women were given oral administration of warfarin during the whole course of pregnancy. The average dose of domestic warfarin was 3.30±0.43 mg/d (87 cases), while the average dose of imported warfarin was 2.90±1.05 mg/d (16 cases). Results None of the patients suffered from serious embolic events. One patient suffered from spontaneous peritoneal hemorrhage. There were 4 cases of intrauterine deaths, and 5 cases of fetal malformation including 1 case of Down’s syndrome and 4 cases of hydrocephalus. Six cases of low birth weight infants and 1 case of ABO hemolytic disease were also found. All the other neonates were healthy with normal weight. No pregnant women suffered from postpartum hemorrhage. Conclusion Oral administration of low dose warfarin (lt;5 mg/d) during the whole course of pregnancy is a relative safe and effective anticoagulation protocol.
Objective To improve the treatment effectiveness of coronary artery fistula by summarizing and analyzing the clinical experiences of its surgical procedures. Methods We retrospectively analyzed the clinical data of 47 patients, 25 males and 22 females, with coronary artery fistula who were hospitalized from January 2003 to December 2008. The age of the patients ranged from 9 months to 63 years old(mean age of 34 years). Thirtytwo cases without associated intracardiac abnormalities were given surgical closure of fistula without cardiopulmonary bypass. Ten cases with largesize fistula were repaired directly or with a patch under cardiopulmonary bypass. Coexisted heart abnormalities were treated simultaneously. Results There were 26 cases of right coronary artery fistula,17 cases of left coronary artery fistula and 4 cases of fistula of both coronary arteries; 17 cases of coronary artery fistula opening into the right ventricle, 8 cases opening into the right atrium, 12 cases opening into the pulmonary artery, 2 cases opening into the sinus of coronary veins, 3 cases opening into the left atrium, 5 cases opening into the left ventricle; and there were 4 cases of multiple fistulas. No death happened during the operation. All patients received surgical treatment successfully, except for one multiplefistula patient who had remaining fistula after operation. Followup was conducted on 47 patients with the time period ranging from 1 month to 5 years. The color ultrasonic cardiography showed that all patients recovered well except for one multiplefistula patient who had a small remaining fistula. Conclusion Coronary artery fistulas can cause hemodynamic problems with indication for surgical intervention. Surgical operation is quite effective for fistulas of coronary artery.