Contemporary approach to pulmonary arterial hypertension in pregnancy

Purpose: The purpose of our study is to show that women with pulmonary arterial hypertension (PAH) when treated for PAH can have successful outcomes with their high risk pregnancies. Background: The management of pregnant women with pulmonary arterial hypertension is difficult, with many centers continuing to report high mortality rates (\u3e50%). We report our experience with 128 consecutive pregnancies between 2000 and 2015, with 100% maternal survival. Methods: Simple assembly of data for 128 consecutive patients treated at our center or distant consultation (27-US states and 17 other countries). Results: We were involved with 128 pregnant women who birthed 128 live babies. The etiology of the PAH included all causes. The average maternal age was 27 years, average mean pulmonary artery pressure was 47mmHg, average length of hospital stay was 5 days, 1 elective termination at 22 weeks, 17 Cesarean sections and 111 vaginal deliveries, with 128 live babies including one set of twins. Seven women have had multiple pregnancies while on PAH treatment. Medications included all PAH therapies available in the US, excluding the ERA group. All deliveries were completed between 29 and 36.5 weeks of gestation. Two patients had general anesthesia and 126 had epidural anesthesia. Conclusions: An aggressive, high risk team approach, early deliver, and meticulous post-partum fluid management resulted in successful outcomes in this high risk population, with no fetal or maternal deaths

Patient Controlled Analgesia Post Cardiac Surgery Results in Shorter Hospital Stays

Despite the easy accessibility and common use by orthopedic and gynecologic surgeons, physicians caring for postoperative cardiac surgery pts have been extremely reluctant to prescribe pt controlled analgesia (PCA) pumps for their pts. The major concerns expressed were respiratory depression, overdosing, inadequate pain control, and loss of “control” by the physician/nursing staff.Sixty pts who were scheduled to undergo myocardial revascularization were selected and asked to participate in the study. Thirty were used as controls and received standard postoperative pain management. Thirty (age, sex, & procedure matched) subjects were asked to use the PCA pump postoperatively. Five pts in each group were “redo”’ surgeries.Amount of MSO4 used during consecutive eight hour periods beginning four hours after endotracheal extubation1234567Control Group12mg8mg10mgpillspillspillspillsPCA Group7mg6mg6mg5mg5mg4mg3mgAverage length of hospital stay for the control group was 7.2 days, while it was 5.8 in the PCA pump group (p<0.1). The reasons for earlier discharge were earlier participation in rehab, less nausea from decreased use of oral pain meds, better pain control, and less atelectasis and pulmonary infiltrates on CXR. Cost of hospital stay was significantly less in the PCA group (p<0.01). The major difficulty with this approach to postoperative pain management is reorientation of both the physician and nursing staff. Only one pt had a complications of over sedation with the PCA pump, because of family interference.Overall, pts can be managed with PCA pumps post cardiac surgery safely, with less cost, and greater pt satisfaction than by the current standard of IV MSO4 and pain pills administered by a nurse

Pulmonary Hypertension

Video/audio recording of Aurora St. Luke\u27s Transplant Grand Rounds on January 27, 2016 presented by Dr. Dianne Zwicke and Sara Paulus, PA. 62 minutes