Zavala-Barrios B, García-Castanedo C, Viruez-Soto JA, Briones-Garduño JC, Coronel-Cruz F

Language: Spanish
References: 26
Page: 627-634
PDF size: 438.30 Kb.

ABSTRACT

Aortic aneurysms are a rare condition in childhood and youth, etiology, evolution, natural progression and prognosis in pregnancy unknown. Hyperthyroidism occurs when there is a synthesis and/or excessive secretion of thyroid hormones during pregnancy poses difficulty for diagnosis. The new monitoring hemodynamics in pregnancy by transthoracic bioimpedance is a feasible alternative, noninvasive and real-time hemodynamic monitoring pregnant women.
Case report: Primiparity 18, is referred to present tachycardia, hyperthyroidism is diagnosed and drug treatment is initiated with antithyroid from week 14.1 echocardiogram reports bivalve aortic aneurysm in the sinus of Valsalva is performed. He was determined to continue the same under strict hemodynamic and fetal monitoring. Pregnancy concludes at the end obtained through the abdomen, at 40.4 weeks, with male product, weight 2250 g, Apgar 9/9, with growth restriction type I. The mother and baby were discharged simultaneously without complications.
Conclussions: The hyperdynamic state of pregnant patients in hyperthyroidism and aneurysms is complex and potentially complicable is why the hemodynamic patient monitoring is essential to detect changes in it that endanger the life of the binomial to this condition. Heart disease and hyperthyroidism, in this case, consistent with a fetal complications level is described as intrauterine growth restriction, however narrow and multidisciplinary monitoring and timely interventions binomial lead to satisfactory results in this case.

REFERENCES

1. Wadia RS, Schwartz JM, Kudchadkar SR. Acute renal and hepatic failure in an adolescent: an unusual presentation of multiple aortic aneurysms. Peds Emerg Care 2014. [En línea]. Dirección URL: .

2. Nakamura Y, Ryugo M, Shikata F, Okura M, Okamura T, Yasugi T, Izutani H. The analysis of ascending aortic dilatation in patients with a bicuspid aortic valve using the ratio of the diameters of the ascending and descending aorta. J Cardiothorac Surg 2014;9:108.

3. Robinson R. Aortic aneurysm in pregnancy a case study. Dimens crit care nurs. 2005;24(1):21-24.

4. Boodhwani M, Andelfinger G, Leipsic J, Lindsay T, McMurtry MS, Therrien J, Siu SC, Canadian Cardiovascular Society Position Statement on the Management of Thoracic Aortic Disease. Can J Cardiol 2014;30(6):577-89.

5. Martin C, Sun W, Elefteriades J. Patient-specific finite element analysis of ascending aorta aneurysms. Am Physiol Soc 2015;308:H1306-16.

6. Darrell W, Shen YH, Russell L, Coselli J, LeMaire SA. Molecular mechanisms of thoracic aortic dissection. J Surg Res 2013;184(2):907-924.

7. Verma S, Siu SC. Aortic dilatation in patients with bicuspid aortic valve. N Eng J Med 2014;370:1920-9.

8. Cury M, Zeidan F, Lobato AC. Aortic disease in the young: genetic aneurysm syndromes, connective tissue disorders, and familial aortic aneurysms and dissections. Int J Vasc Med 2013;267215.

9. Braverman AC. Medical management of thoracic aortic aneurysm disease. J Thor Cardiovasc Surg 2012;145(2):S2- S6.

10. van Hagen IM, Roos Hesselink JW. Aorta pathology and pregnancy. Best Pract Res Clin Obstet Gynaecol 2014;28:537-50.

11. Muiño Mosquera L, De Backer J. Managing aortic aneurysms and dissections during pregnancy. Expert Rev Cardiovasc Ther 2015;13(6):703-14.

12. Sullivan J, Ramanathan KB. Management of medical problems in pregnancy: severe cardiac disease. N Eng J Med 1995;313(5):304-309.

13. Mandel W, Warren EW, Walford RL. Disecting aortic aneurysm during pregnancy. N Eng J Med 1984;251(26):1059- 1061.

14. Diagnóstico y tratamiento de la enfermedad de Graves en >18 años. México: Secretaria de Salud, 2011.

15. Cignini P, Cafa EV, Gioriandino C, Capriglione S, Spata A, Dugo N. Thyroid physiology and common diseases in pregnancy: review of literatura. J Prenat Med 2012;6(4):64-71.

16. Galofre JC, Davies TF. Autoimmune thyroid disease in pregnancy: a review. J Women’s Health 2009;18(11):1847-1856.

17. De Groot L, et. al. Management of thyroid dysfunction during pregnancy and postpartum: an Endocrine Society Clinical Practice Guideline. J Clin Endocrinol Metab 2012;97(8):2543-2565.

18. De Escobar GM, Obregón MJ, del Rey FE. Maternal thyroid hormones early in pregnancy and fetal brain development. Best Pract Res Clin Endocrinol Metab 2004;18:225-248.

19. Männistö T, Mendola P, Grewal J, Xie Y, et al. Thyroid diseases and adverse pregnancy outcomes. J Clin Endocrinol Metab 2013;98(7):2725-2733.

20. Alamdari S, Azizi F, Delshad H, Sarvghadi F, Amouzergar A, Mehran L. Management of hyperthyroidism in preganancy: comparison of recomendations of American thyroid Association and Endocrine Society. J Thyroid Res 2013:878467.

21. Fitzpatrick DL, Russell MA. Diagnosis and management of thyroid disease in pregnancy. Obstet Gynecol Clin N Am 2010;37:173-193.

22. Kubicek WG, Karnegis JN, Patterson RP, Witsoe DA, Mattson RH. Development and evaluation of an impedance cardiac output system. Aerosp Med 1966;37:1208-1212.

23. Meneses-Calderón J, Díaz de León-Ponce M, Moreno- Santillán AA, González-Díaz JI, y col. Medición de valores hemodinámicos en embarazo normoevolutivo y puerperio inmediato por bioimpedancia torácica. Rev Asoc Mex Med Crit y Ter Int 2007;21(3):149-153.

24. Kuivaniemi H, Ryer EJ, Elmore J, Hinterseher I, Smelser D, Tromp G. Update on abdominal aortic aneurysm research: from clinical to genetic studies. Scientifica 2014;564734.

25. Viruez-Soto JA, Briones-Garduño JC, Díaz de León-Ponce JM, Briones-Vega CG. Optimización del gasto cardiaco en preeclampsia severa. Rev Asoc Mex Med Crit y Ter Int 2014;28(4):216-220.

26. Meneses-Calderón J, Santillán-Moreno AA, González-Díaz JI, Díaz de León-Ponce JM, y col. Medición hemodinámica en preeclampsia severa. Rev Asoc Mex Med Crit y Ter Int 2008;22(1):10-14.