Fahimeh Kashfi - Academia.edu (original) (raw)
Papers by Fahimeh Kashfi
Iranian Journal of …, 2010
SYMPTOMS OF NATURAL MENOPAUSE AMONG IRANIAN WOMEN LIVING IN TEHRAN, IRAN ASHRAFI MAHNAZ*,KAZEMI A... more SYMPTOMS OF NATURAL MENOPAUSE AMONG IRANIAN WOMEN LIVING IN TEHRAN, IRAN ASHRAFI MAHNAZ*,KAZEMI ASHTIANI S.,MALEKZADEH F.,AMIR CHAGHMAGHI E.,KASHFI F.,ESHRATI B.,SHABANI F. * DEPARTMENT OF ENDOCRINOLOGY AND FEMALE ...
The Annals of Thoracic Surgery, 2016
A pregnant patient presented with symptomatic ventricular tachycardia. Echocardiography revealed ... more A pregnant patient presented with symptomatic ventricular tachycardia. Echocardiography revealed a large intramyocardial mass. Surgical resection was attempted in Fig 3. Computed tomographic angiographic view after endovascular repair of abdominal aortic aneurysm.
The Journal of Tehran University Heart Center, 2007
Background: Cardiovascular disease is an important non-obstetric cause of maternal and fetal /neo... more Background: Cardiovascular disease is an important non-obstetric cause of maternal and fetal /neonatal morbidity and mortality during pregnancy. For a pregnant woman with cardiac disease, the potential inability of the maternal cardiovascular system to contend with normal pregnancy-induced physiologic changes may produce deleterious effects on both mother and fetus. To determine the most frequent surgical indications of maternal and fetal mortality, we studied 15 cases of severe cardiac disease in pregnant women who required cardiac surgical procedures. Methods: In this descriptive study, fifteen pregnant women who underwent cardiac surgery were studied. Maternal age ranged from 27 to 36 years, and gestational age varied from 4 to 22 weeks. Most of the patients were in New York Heart Association Classes II and III. Opioid- based anesthesia with fentanyl citrate (50µ/kg) or sufentanil (5µ/kg) plus low dose of thiopental were used for the induction of anesthesia. During non-pulsatile ...
JOURNAL OF REPRODUCTION AND INFERTILITY, 2005
Kashfi F. (M.Sc.) , Tabatabaie M.B. (M.D.), Khamoushi A.J. (M.D.), Hosseini S. (M.D.), Sadeghpour... more Kashfi F. (M.Sc.) , Tabatabaie M.B. (M.D.), Khamoushi A.J. (M.D.), Hosseini S. (M.D.), Sadeghpour A. (M.D.), Alizadeh-Ghavidel A.R. (M.D.). 1Master′s Degree of Midwifery, Department of Cardiac Surgery and Cardiology, Rajaie Heart Center, Tehran, Iran. 2Department of Epidemiology, Rouyan Institute, Tehran, Iran. 3Associate Professor, Department of Cardiac Surgery and Cardiology, Rajaie Heart Center, Tehran, Iran. 4Assistant Professor, Department of Cardiac Surgery and Cardiology, Rajaie Heart Center, Tehran, Iran.
The Journal of heart valve disease, 2015
BACKGROUND AND AIM OF THE STUDY Cardiac surgery during pregnancy is rarely required and potential... more BACKGROUND AND AIM OF THE STUDY Cardiac surgery during pregnancy is rarely required and potentially increases feto-maternal mortality. The study aim was to evaluate pregnancy outcomes in females who underwent open-heart surgery with cardiopulmonary bypass (CPB) during pregnancy. METHODS Between 1999 and 2014, a total of 16 pregnant women (mean age 27 ± 7 years; mean gestational age 13 ± 7.7 weeks) underwent urgent cardiac surgery using CPB. The preoperative diagnosis included prosthetic valve dysfunction in 12 women (five aortic, seven mitral), native valve endocarditis and critical aortic stenosis each in one woman, and intracardiac masses in two women. Eleven patients were in the first trimester, three in the second trimester, and two in the third trimester. A retrospective analysis was conducted that included maternal variables of age, gestational age, cardiac diagnosis, prior operations, surgical details, maternal morbidity and mortality and type of delivery, while fetal variabl...
Cell journal, Jul 1, 2018
The regenerative potential of bone marrow-derived mononuclear cells (MNCs) and CD133+ stem cells ... more The regenerative potential of bone marrow-derived mononuclear cells (MNCs) and CD133+ stem cells in the heart varies in terms of their pro-angiogenic effects. This phase II/III, multicenter and double-blind trial is designed to compare the functional effects of intramyocardial autologous transplantation of both cell types and placebo in patients with recent myocardial infarction (RMI) post-coronary artery bypass graft. This was a phase II/III, randomized, double-blind, placebo-controlled trial COMPARE CPM-RMI (CD133, Placebo, MNCs - recent myocardial infarction) conducted in accordance with the Declaration of Helsinki that assessed the safety and efficacy of CD133 and MNCs compared to placebo in patients with RMI. We randomly assigned 77 eligible RMI patients selected from 5 hospitals to receive CD133+ cells, MNC, or a placebo. Patients underwent gated single photon emission computed tomography assessments at 6 and 18 months post-intramyocardial transplantation. We tested the normal...
The American Journal of Cardiology, 2016
Iranian Journal of Fertility Sterility, 2007
Background: The etiology of infertility has direct influence on the plan and outcome of its manag... more Background: The etiology of infertility has direct influence on the plan and outcome of its management. In this paper we showed the effect of history of tuberculosis (TB) on female infertility among infertile couples admitted to Royan infertility management center. Material and Methods: This case control study was performed on cases that were diagnosed with female infertility (308 women). Controls were women whose husbands were infertile due to some male factor (314 women). Those who had both female and male infertility were excluded from the study. The observed variables were BMI>25 kg/m 2 , positive history of smoking, tuberculosis, sexually transmitted disease and pelvic inflammatory diseases. Results: The age adjusted odds ratio of history of tuberculosis for female infertility was 6.21(95 CI: 1.31-29.56).The attributable risk in exposed group was about 1%. Conclusion: According to our study, positive history of tuberculosis may be responsible for female infertility.
The Journal of heart valve disease, 2015
Cardiac surgery during pregnancy is rarely required and potentially increases feto-maternal morta... more Cardiac surgery during pregnancy is rarely required and potentially increases feto-maternal mortality. The study aim was to evaluate pregnancy outcomes in females who underwent open-heart surgery with cardiopulmonary bypass (CPB) during pregnancy. Between 1999 and 2014, a total of 16 pregnant women (mean age 27 ± 7 years; mean gestational age 13 ± 7.7 weeks) underwent urgent cardiac surgery using CPB. The preoperative diagnosis included prosthetic valve dysfunction in 12 women (five aortic, seven mitral), native valve endocarditis and critical aortic stenosis each in one woman, and intracardiac masses in two women. Eleven patients were in the first trimester, three in the second trimester, and two in the third trimester. A retrospective analysis was conducted that included maternal variables of age, gestational age, cardiac diagnosis, prior operations, surgical details, maternal morbidity and mortality and type of delivery, while fetal variables included incidence of low birth weigh...
Arak Medical University Journal, 2006
Introduction: The reason of infertility can have a direct influence on the plan and outcome of ma... more Introduction: The reason of infertility can have a direct influence on the plan and outcome of management. In this paper we intend to show the effect of tuberculosis (TB) history on female infertility among infertile couples attending to Rooyan infertility management center. Materials and methods: In this case-control study our cases were those who were diagnosed as infertile female and controls were those women whose husbands were infertile due to some male factor. We used logestic regression for analyzing the association of history of Tuberculosis and female infertility with attributable risk estimation. Results: 308 cases were compared to 314 controls. Considering the odds ratio and its 95% confidence interval, there was a significant difference between the history of TB and infertility (OR=4.7, 95% CI: 1.01-29.91). The attributable risk of TB for female infertility was 0.023±0.01 (which is significant at 5% level). Conclusion: These figures show that at least 2% of female infertility can be prevented by prevention and proper treatment of tuberculosis.
International journal of fertility & sterility
Background Pregnancy is associated with a hypercoagulable state, therefore the optimal anticoagul... more Background Pregnancy is associated with a hypercoagulable state, therefore the optimal anticoagulants for potential use in pregnant women with prosthetic heart valves are controversial. The aim of this study is to investigate the effect of anticoagulants on pregnancy outcomes and their potential risks in pregnant women with mechanical heart valves. Materials and Methods In this prospective cohort study, we followed 44 women with 49 pregnancies who had mechanical heart valves from September 2002 to September 2007. A total of 38 patients took warfarin throughout their pregnancies (group A). In 11 patients, warfarin was changed to heparin during the first trimester and then again to warfarin during 12thto 36thweeks of gestational age (group B). All women took warfarin from 36thweeks of gestational age until delivery. Results In group A, there were 22 live births (57.9%), 15 abortions (39.5%) and 1 maternal death (2.6%). In group B, there were seven live births (63.6%), three spontaneou...
Pregnant patients with mechanical heart valves require anticoagulation. The risk of bleeding and ... more Pregnant patients with mechanical heart valves require anticoagulation. The risk of bleeding and embryopathy associated with oral anticoagulants must be weighed against the risk of valve thrombosis. In this prospective study, undertaken between 1999 and 2009, 53 pregnancies (47 women with mechanical mitral valves; 29.8 ± 4.8 years old) were studied. Patients were divided into two groups: group I (n = 43) received Warfarin throughout the pregnancy, while group II (n = 10) received Heparin in the first trimester and then Warfarin until the 36(th) week. Thirty-two (60.4%) pregnancies resulted in live births, whereas 18 (34%) abortions, 2 (3.8%) stillbirths, and one (1.9%) maternal death occurred. In group I, there were 26 (60.5%) live births, one (2.3%) stillbirth, and 15 (34.9%) abortions. In group II, there were 6 (60%) live births, one (10%) stillbirth, and 3 (30%) abortions. There were no significant differences between the two groups in terms of fetal outcome. Thirty-nine (90.7%) ...
Background: This study was conducted to estimate the prevalence of sub-fertility in Tehran ( Iran... more Background: This study was conducted to estimate the prevalence of sub-fertility in Tehran ( Iran ). Materials and Methods: The survey method was descriptive- Interview in 22 Municipal district ( Iran ) and a representative sample of women who were in their fertility age (2545) were selected. After exclusion of 13 cases not meeting age criteria and 190 non-respondent cases 1987 remained. Results: For this large city with a population of about seven million at the time of the study, we estimated the cumulative incidence of sub-fertility in 2001 to be 12.6% ...
The journal of Tehran Heart Center, 2012
Pregnant patients with mechanical heart valves require anticoagulation. The risk of bleeding and ... more Pregnant patients with mechanical heart valves require anticoagulation. The risk of bleeding and embryopathy associated with oral anticoagulants must be weighed against the risk of valve thrombosis. In this prospective study, undertaken between 1999 and 2009, 53 pregnancies (47 women with mechanical mitral valves; 29.8 ± 4.8 years old) were studied. Patients were divided into two groups: group I (n = 43) received Warfarin throughout the pregnancy, while group II (n = 10) received Heparin in the first trimester and then Warfarin until the 36(th) week. Thirty-two (60.4%) pregnancies resulted in live births, whereas 18 (34%) abortions, 2 (3.8%) stillbirths, and one (1.9%) maternal death occurred. In group I, there were 26 (60.5%) live births, one (2.3%) stillbirth, and 15 (34.9%) abortions. In group II, there were 6 (60%) live births, one (10%) stillbirth, and 3 (30%) abortions. There were no significant differences between the two groups in terms of fetal outcome. Thirty-nine (90.7%) ...
![Research paper thumbnail of [Anticoagulation during pregnancy in women with implanted heart valve prostheses]](https://attachments.academia-assets.com/72141317/thumbnails/1.jpg)
](Kardiologia polska, 2012
Background: Pregnancy is associated with a hypercoagulable state, therefore the optimal anticoagu... more Background: Pregnancy is associated with a hypercoagulable state, therefore the optimal anticoagulants for potential use in pregnant women with prosthetic heart valves are controversial. The aim of this study is to investigate the effect of anticoagulants on pregnancy outcomes and their potential risks in pregnant women with mechanical heart valves. Materials and Methods: In this prospective cohort study, we followed 44 women with 49 pregnancies who had mechanical heart valves from September 2002 to September 2007. A total of 38 patients took warfarin throughout their pregnancies (group A). In 11 patients, warfarin was changed to heparin during the first trimester and then again to warfarin during 12 th to 36 th weeks of gestational age (group B). All women took warfarin from 36 th weeks of gestational age until delivery. Results: In group A, there were 22 live births (57.9%), 15 abortions (39.5%) and 1 maternal death (2.6%). In group B, there were seven live births (63.6%), three spontaneous abortions (27.3%) and one intra-uterine fetal death (9.1%). There was no significant difference in live birth rate between the two groups (p=0.24). Thirty-three pregnancies (86.8%) in group A and five pregnancies (45.4%) in group B had no maternal complications (p=0.004). The difference in pregnancy complications between both groups was significant (p<0.001) Conclusion: The present study shows that low dose warfarin (5 mg/day or less) may be safe during the first trimester of pregnancy. Maternal adverse events are low when pregnant women with mechanical heart valves remain on a warfarin regimen. The risk of embryopathy does not necessarily increase.
There is an increased risk of thromboembolism, anticoagulant-related hemorrhage, fetal-wastage an... more There is an increased risk of thromboembolism, anticoagulant-related hemorrhage, fetal-wastage and congestive cardiac failure in pregnant women with mechanical heart valves. In order to have a good outcome, the care of such patients must necessarily be multidisciplinary and in a well- equipped centre with adequate support services .One such patient who had mechanical mitral and aortic valves replacement in 2000 receiving warfarin anticoagulant therapy, presented with a first trimester pregnancy by ICSI method in 2006. She remained in stable homodynamic state and went through pregnancy without event. Delivery was done by caesarian section at 37 weeks gestation age. With considering use of warfarin during pregnancy, use of stimulation protocol during ICSI and delivering normal neonate ultimately, this interesting case is presented herein.
Pediatric Cardiology, 2012
We report a 5-year-old boy weighing 11 kg, with severe mitral valve stenosis of rheumatic aetiolo... more We report a 5-year-old boy weighing 11 kg, with severe mitral valve stenosis of rheumatic aetiology, who underwent successful percutaneous transluminal mitral commissurotomy (PTMC) with valvuloplasty balloon. Postprocedural mean pressure gradient across the mitral valve decreased to 6 mmHg from an initially recorded value of 22 mmHg. In addition to symptomatic improvement, the mitral valvular area increased from 0.4 to 0.8 cm 2 without significant change in mitral regurgitation. At 1-and 3-month follow up, transthoracic echocardiography revealed further improvement with an increase in mitral valve area to 1.0 cm 2 , a decrease in pulmonary arterial pressure, and a mean mitral valve pressure gradient of 8 mmHg with trivial mitral regurgitation. To best of our knowledge, this is the first successful PTMC procedure performed in the youngest and smallest ever reported child with rheumatic mitral stenosis (MS). We conclude that PTMC with valvuloplasty balloon could be a logical alternative to surgery in young patients with rheumatic MS.
Asian Cardiovascular and Thoracic Annals, 2007
Introduction: The reason of infertility can have a direct influence on the plan and outcome of ma... more Introduction: The reason of infertility can have a direct influence on the plan and outcome of management. In this paper we intend to show the effect of tuberculosis (TB) history on female infertility among infertile couples attending to Rooyan infertility management center. Materials and methods: In this case-control study our cases were those who were diagnosed as infertile female and controls were those women whose husbands were infertile due to some male factor. We used logestic regression for analyzing the association of history of Tuberculosis and female infertility with attributable risk estimation. Results: 308 cases were compared to 314 controls. Considering the odds ratio and its 95% confidence interval, there was a significant difference between the history of TB and infertility (OR=4.7, 95% CI: 1.01-29.91). The attributable risk of TB for female infertility was 0.023±0.01 (which is significant at 5% level). Conclusion: These figures show that at least 2% of female infertility can be prevented by prevention and proper treatment of tuberculosis.
Background: The etiology of infertility has direct influence on the plan and outcome of its manag... more Background: The etiology of infertility has direct influence on the plan and outcome of its management. In this paper we showed the effect of history of tuberculosis (TB) on female infertility among infertile couples admitted to Royan infertility management center. Material and Methods: This case control study was performed on cases that were diagnosed with female infertility (308 women). Controls were women whose husbands were infertile due to some male factor (314 women). Those who had both female and male infertility were excluded from the study. The observed variables were BMI>25 kg/m 2 , positive history of smoking, tuberculosis, sexually transmitted disease and pelvic inflammatory diseases. Results: The age adjusted odds ratio of history of tuberculosis for female infertility was 6.21(95 CI: 1.31-29.56).The attributable risk in exposed group was about 1%. Conclusion: According to our study, positive history of tuberculosis may be responsible for female infertility.
Iranian Journal of …, 2010
SYMPTOMS OF NATURAL MENOPAUSE AMONG IRANIAN WOMEN LIVING IN TEHRAN, IRAN ASHRAFI MAHNAZ*,KAZEMI A... more SYMPTOMS OF NATURAL MENOPAUSE AMONG IRANIAN WOMEN LIVING IN TEHRAN, IRAN ASHRAFI MAHNAZ*,KAZEMI ASHTIANI S.,MALEKZADEH F.,AMIR CHAGHMAGHI E.,KASHFI F.,ESHRATI B.,SHABANI F. * DEPARTMENT OF ENDOCRINOLOGY AND FEMALE ...
The Annals of Thoracic Surgery, 2016
A pregnant patient presented with symptomatic ventricular tachycardia. Echocardiography revealed ... more A pregnant patient presented with symptomatic ventricular tachycardia. Echocardiography revealed a large intramyocardial mass. Surgical resection was attempted in Fig 3. Computed tomographic angiographic view after endovascular repair of abdominal aortic aneurysm.
The Journal of Tehran University Heart Center, 2007
Background: Cardiovascular disease is an important non-obstetric cause of maternal and fetal /neo... more Background: Cardiovascular disease is an important non-obstetric cause of maternal and fetal /neonatal morbidity and mortality during pregnancy. For a pregnant woman with cardiac disease, the potential inability of the maternal cardiovascular system to contend with normal pregnancy-induced physiologic changes may produce deleterious effects on both mother and fetus. To determine the most frequent surgical indications of maternal and fetal mortality, we studied 15 cases of severe cardiac disease in pregnant women who required cardiac surgical procedures. Methods: In this descriptive study, fifteen pregnant women who underwent cardiac surgery were studied. Maternal age ranged from 27 to 36 years, and gestational age varied from 4 to 22 weeks. Most of the patients were in New York Heart Association Classes II and III. Opioid- based anesthesia with fentanyl citrate (50µ/kg) or sufentanil (5µ/kg) plus low dose of thiopental were used for the induction of anesthesia. During non-pulsatile ...
JOURNAL OF REPRODUCTION AND INFERTILITY, 2005
Kashfi F. (M.Sc.) , Tabatabaie M.B. (M.D.), Khamoushi A.J. (M.D.), Hosseini S. (M.D.), Sadeghpour... more Kashfi F. (M.Sc.) , Tabatabaie M.B. (M.D.), Khamoushi A.J. (M.D.), Hosseini S. (M.D.), Sadeghpour A. (M.D.), Alizadeh-Ghavidel A.R. (M.D.). 1Master′s Degree of Midwifery, Department of Cardiac Surgery and Cardiology, Rajaie Heart Center, Tehran, Iran. 2Department of Epidemiology, Rouyan Institute, Tehran, Iran. 3Associate Professor, Department of Cardiac Surgery and Cardiology, Rajaie Heart Center, Tehran, Iran. 4Assistant Professor, Department of Cardiac Surgery and Cardiology, Rajaie Heart Center, Tehran, Iran.
The Journal of heart valve disease, 2015
BACKGROUND AND AIM OF THE STUDY Cardiac surgery during pregnancy is rarely required and potential... more BACKGROUND AND AIM OF THE STUDY Cardiac surgery during pregnancy is rarely required and potentially increases feto-maternal mortality. The study aim was to evaluate pregnancy outcomes in females who underwent open-heart surgery with cardiopulmonary bypass (CPB) during pregnancy. METHODS Between 1999 and 2014, a total of 16 pregnant women (mean age 27 ± 7 years; mean gestational age 13 ± 7.7 weeks) underwent urgent cardiac surgery using CPB. The preoperative diagnosis included prosthetic valve dysfunction in 12 women (five aortic, seven mitral), native valve endocarditis and critical aortic stenosis each in one woman, and intracardiac masses in two women. Eleven patients were in the first trimester, three in the second trimester, and two in the third trimester. A retrospective analysis was conducted that included maternal variables of age, gestational age, cardiac diagnosis, prior operations, surgical details, maternal morbidity and mortality and type of delivery, while fetal variabl...
Cell journal, Jul 1, 2018
The regenerative potential of bone marrow-derived mononuclear cells (MNCs) and CD133+ stem cells ... more The regenerative potential of bone marrow-derived mononuclear cells (MNCs) and CD133+ stem cells in the heart varies in terms of their pro-angiogenic effects. This phase II/III, multicenter and double-blind trial is designed to compare the functional effects of intramyocardial autologous transplantation of both cell types and placebo in patients with recent myocardial infarction (RMI) post-coronary artery bypass graft. This was a phase II/III, randomized, double-blind, placebo-controlled trial COMPARE CPM-RMI (CD133, Placebo, MNCs - recent myocardial infarction) conducted in accordance with the Declaration of Helsinki that assessed the safety and efficacy of CD133 and MNCs compared to placebo in patients with RMI. We randomly assigned 77 eligible RMI patients selected from 5 hospitals to receive CD133+ cells, MNC, or a placebo. Patients underwent gated single photon emission computed tomography assessments at 6 and 18 months post-intramyocardial transplantation. We tested the normal...
The American Journal of Cardiology, 2016
Iranian Journal of Fertility Sterility, 2007
Background: The etiology of infertility has direct influence on the plan and outcome of its manag... more Background: The etiology of infertility has direct influence on the plan and outcome of its management. In this paper we showed the effect of history of tuberculosis (TB) on female infertility among infertile couples admitted to Royan infertility management center. Material and Methods: This case control study was performed on cases that were diagnosed with female infertility (308 women). Controls were women whose husbands were infertile due to some male factor (314 women). Those who had both female and male infertility were excluded from the study. The observed variables were BMI>25 kg/m 2 , positive history of smoking, tuberculosis, sexually transmitted disease and pelvic inflammatory diseases. Results: The age adjusted odds ratio of history of tuberculosis for female infertility was 6.21(95 CI: 1.31-29.56).The attributable risk in exposed group was about 1%. Conclusion: According to our study, positive history of tuberculosis may be responsible for female infertility.
The Journal of heart valve disease, 2015
Cardiac surgery during pregnancy is rarely required and potentially increases feto-maternal morta... more Cardiac surgery during pregnancy is rarely required and potentially increases feto-maternal mortality. The study aim was to evaluate pregnancy outcomes in females who underwent open-heart surgery with cardiopulmonary bypass (CPB) during pregnancy. Between 1999 and 2014, a total of 16 pregnant women (mean age 27 ± 7 years; mean gestational age 13 ± 7.7 weeks) underwent urgent cardiac surgery using CPB. The preoperative diagnosis included prosthetic valve dysfunction in 12 women (five aortic, seven mitral), native valve endocarditis and critical aortic stenosis each in one woman, and intracardiac masses in two women. Eleven patients were in the first trimester, three in the second trimester, and two in the third trimester. A retrospective analysis was conducted that included maternal variables of age, gestational age, cardiac diagnosis, prior operations, surgical details, maternal morbidity and mortality and type of delivery, while fetal variables included incidence of low birth weigh...
Arak Medical University Journal, 2006
Introduction: The reason of infertility can have a direct influence on the plan and outcome of ma... more Introduction: The reason of infertility can have a direct influence on the plan and outcome of management. In this paper we intend to show the effect of tuberculosis (TB) history on female infertility among infertile couples attending to Rooyan infertility management center. Materials and methods: In this case-control study our cases were those who were diagnosed as infertile female and controls were those women whose husbands were infertile due to some male factor. We used logestic regression for analyzing the association of history of Tuberculosis and female infertility with attributable risk estimation. Results: 308 cases were compared to 314 controls. Considering the odds ratio and its 95% confidence interval, there was a significant difference between the history of TB and infertility (OR=4.7, 95% CI: 1.01-29.91). The attributable risk of TB for female infertility was 0.023±0.01 (which is significant at 5% level). Conclusion: These figures show that at least 2% of female infertility can be prevented by prevention and proper treatment of tuberculosis.
International journal of fertility & sterility
Background Pregnancy is associated with a hypercoagulable state, therefore the optimal anticoagul... more Background Pregnancy is associated with a hypercoagulable state, therefore the optimal anticoagulants for potential use in pregnant women with prosthetic heart valves are controversial. The aim of this study is to investigate the effect of anticoagulants on pregnancy outcomes and their potential risks in pregnant women with mechanical heart valves. Materials and Methods In this prospective cohort study, we followed 44 women with 49 pregnancies who had mechanical heart valves from September 2002 to September 2007. A total of 38 patients took warfarin throughout their pregnancies (group A). In 11 patients, warfarin was changed to heparin during the first trimester and then again to warfarin during 12thto 36thweeks of gestational age (group B). All women took warfarin from 36thweeks of gestational age until delivery. Results In group A, there were 22 live births (57.9%), 15 abortions (39.5%) and 1 maternal death (2.6%). In group B, there were seven live births (63.6%), three spontaneou...
Pregnant patients with mechanical heart valves require anticoagulation. The risk of bleeding and ... more Pregnant patients with mechanical heart valves require anticoagulation. The risk of bleeding and embryopathy associated with oral anticoagulants must be weighed against the risk of valve thrombosis. In this prospective study, undertaken between 1999 and 2009, 53 pregnancies (47 women with mechanical mitral valves; 29.8 ± 4.8 years old) were studied. Patients were divided into two groups: group I (n = 43) received Warfarin throughout the pregnancy, while group II (n = 10) received Heparin in the first trimester and then Warfarin until the 36(th) week. Thirty-two (60.4%) pregnancies resulted in live births, whereas 18 (34%) abortions, 2 (3.8%) stillbirths, and one (1.9%) maternal death occurred. In group I, there were 26 (60.5%) live births, one (2.3%) stillbirth, and 15 (34.9%) abortions. In group II, there were 6 (60%) live births, one (10%) stillbirth, and 3 (30%) abortions. There were no significant differences between the two groups in terms of fetal outcome. Thirty-nine (90.7%) ...
Background: This study was conducted to estimate the prevalence of sub-fertility in Tehran ( Iran... more Background: This study was conducted to estimate the prevalence of sub-fertility in Tehran ( Iran ). Materials and Methods: The survey method was descriptive- Interview in 22 Municipal district ( Iran ) and a representative sample of women who were in their fertility age (2545) were selected. After exclusion of 13 cases not meeting age criteria and 190 non-respondent cases 1987 remained. Results: For this large city with a population of about seven million at the time of the study, we estimated the cumulative incidence of sub-fertility in 2001 to be 12.6% ...
The journal of Tehran Heart Center, 2012
Pregnant patients with mechanical heart valves require anticoagulation. The risk of bleeding and ... more Pregnant patients with mechanical heart valves require anticoagulation. The risk of bleeding and embryopathy associated with oral anticoagulants must be weighed against the risk of valve thrombosis. In this prospective study, undertaken between 1999 and 2009, 53 pregnancies (47 women with mechanical mitral valves; 29.8 ± 4.8 years old) were studied. Patients were divided into two groups: group I (n = 43) received Warfarin throughout the pregnancy, while group II (n = 10) received Heparin in the first trimester and then Warfarin until the 36(th) week. Thirty-two (60.4%) pregnancies resulted in live births, whereas 18 (34%) abortions, 2 (3.8%) stillbirths, and one (1.9%) maternal death occurred. In group I, there were 26 (60.5%) live births, one (2.3%) stillbirth, and 15 (34.9%) abortions. In group II, there were 6 (60%) live births, one (10%) stillbirth, and 3 (30%) abortions. There were no significant differences between the two groups in terms of fetal outcome. Thirty-nine (90.7%) ...
Kardiologia polska, 2012
Background: Pregnancy is associated with a hypercoagulable state, therefore the optimal anticoagu... more Background: Pregnancy is associated with a hypercoagulable state, therefore the optimal anticoagulants for potential use in pregnant women with prosthetic heart valves are controversial. The aim of this study is to investigate the effect of anticoagulants on pregnancy outcomes and their potential risks in pregnant women with mechanical heart valves. Materials and Methods: In this prospective cohort study, we followed 44 women with 49 pregnancies who had mechanical heart valves from September 2002 to September 2007. A total of 38 patients took warfarin throughout their pregnancies (group A). In 11 patients, warfarin was changed to heparin during the first trimester and then again to warfarin during 12 th to 36 th weeks of gestational age (group B). All women took warfarin from 36 th weeks of gestational age until delivery. Results: In group A, there were 22 live births (57.9%), 15 abortions (39.5%) and 1 maternal death (2.6%). In group B, there were seven live births (63.6%), three spontaneous abortions (27.3%) and one intra-uterine fetal death (9.1%). There was no significant difference in live birth rate between the two groups (p=0.24). Thirty-three pregnancies (86.8%) in group A and five pregnancies (45.4%) in group B had no maternal complications (p=0.004). The difference in pregnancy complications between both groups was significant (p<0.001) Conclusion: The present study shows that low dose warfarin (5 mg/day or less) may be safe during the first trimester of pregnancy. Maternal adverse events are low when pregnant women with mechanical heart valves remain on a warfarin regimen. The risk of embryopathy does not necessarily increase.
There is an increased risk of thromboembolism, anticoagulant-related hemorrhage, fetal-wastage an... more There is an increased risk of thromboembolism, anticoagulant-related hemorrhage, fetal-wastage and congestive cardiac failure in pregnant women with mechanical heart valves. In order to have a good outcome, the care of such patients must necessarily be multidisciplinary and in a well- equipped centre with adequate support services .One such patient who had mechanical mitral and aortic valves replacement in 2000 receiving warfarin anticoagulant therapy, presented with a first trimester pregnancy by ICSI method in 2006. She remained in stable homodynamic state and went through pregnancy without event. Delivery was done by caesarian section at 37 weeks gestation age. With considering use of warfarin during pregnancy, use of stimulation protocol during ICSI and delivering normal neonate ultimately, this interesting case is presented herein.
Pediatric Cardiology, 2012
We report a 5-year-old boy weighing 11 kg, with severe mitral valve stenosis of rheumatic aetiolo... more We report a 5-year-old boy weighing 11 kg, with severe mitral valve stenosis of rheumatic aetiology, who underwent successful percutaneous transluminal mitral commissurotomy (PTMC) with valvuloplasty balloon. Postprocedural mean pressure gradient across the mitral valve decreased to 6 mmHg from an initially recorded value of 22 mmHg. In addition to symptomatic improvement, the mitral valvular area increased from 0.4 to 0.8 cm 2 without significant change in mitral regurgitation. At 1-and 3-month follow up, transthoracic echocardiography revealed further improvement with an increase in mitral valve area to 1.0 cm 2 , a decrease in pulmonary arterial pressure, and a mean mitral valve pressure gradient of 8 mmHg with trivial mitral regurgitation. To best of our knowledge, this is the first successful PTMC procedure performed in the youngest and smallest ever reported child with rheumatic mitral stenosis (MS). We conclude that PTMC with valvuloplasty balloon could be a logical alternative to surgery in young patients with rheumatic MS.
Asian Cardiovascular and Thoracic Annals, 2007
Introduction: The reason of infertility can have a direct influence on the plan and outcome of ma... more Introduction: The reason of infertility can have a direct influence on the plan and outcome of management. In this paper we intend to show the effect of tuberculosis (TB) history on female infertility among infertile couples attending to Rooyan infertility management center. Materials and methods: In this case-control study our cases were those who were diagnosed as infertile female and controls were those women whose husbands were infertile due to some male factor. We used logestic regression for analyzing the association of history of Tuberculosis and female infertility with attributable risk estimation. Results: 308 cases were compared to 314 controls. Considering the odds ratio and its 95% confidence interval, there was a significant difference between the history of TB and infertility (OR=4.7, 95% CI: 1.01-29.91). The attributable risk of TB for female infertility was 0.023±0.01 (which is significant at 5% level). Conclusion: These figures show that at least 2% of female infertility can be prevented by prevention and proper treatment of tuberculosis.
Background: The etiology of infertility has direct influence on the plan and outcome of its manag... more Background: The etiology of infertility has direct influence on the plan and outcome of its management. In this paper we showed the effect of history of tuberculosis (TB) on female infertility among infertile couples admitted to Royan infertility management center. Material and Methods: This case control study was performed on cases that were diagnosed with female infertility (308 women). Controls were women whose husbands were infertile due to some male factor (314 women). Those who had both female and male infertility were excluded from the study. The observed variables were BMI>25 kg/m 2 , positive history of smoking, tuberculosis, sexually transmitted disease and pelvic inflammatory diseases. Results: The age adjusted odds ratio of history of tuberculosis for female infertility was 6.21(95 CI: 1.31-29.56).The attributable risk in exposed group was about 1%. Conclusion: According to our study, positive history of tuberculosis may be responsible for female infertility.