Loading ...
Sorry, an error occurred while loading the content.

Re: [echocardiography] Pregnancy & saline contrast

Expand Messages
  • Gerson Lichtenberg
    I think that the first question actually is, What do we need to know about this woman while she is still pregnant? If it can wait until after delivery you
    Message 1 of 8 , Feb 28 6:40 PM
    • 0 Attachment
      I think that the first question actually is, "What do
      we need to know about this woman while she is still
      pregnant?" If it can wait until after delivery you
      should do so. If the shunt is small enough that the
      right heart is not enlarged, there is no paradoxic
      septal motion, and there are no systemic emboli, it
      does not seem that there is an immediate need for a
      contrast study.

      If there is concern for a large shunt or a small shunt
      with cardiac involvement as an embolic source, then a
      TEE might be appropriate. This way you assess the
      large ASD for closure or detect the small shunt so
      that the embolic issue can be addressed. Either way,
      you can probably wait until after delivery for a
      trans-thoracic echo with contrast.

      Gerson Lichtenberg, RDCS, APS
      Echo Lab Coordinator
      Mt. Sinai Hospital
      Chicago, Illinois

      --- a b <ginalulubaby@...> wrote:

      > Anyone know the safety guidelines regarding bubble
      > studies for atrial shunting on pregnant women?
      >
      >
      > ---------------------------------
      > Yahoo! Mail
      > Use Photomail to share photos without annoying
      attachments.


      Gerson Lichtenberg, RDCS, APS
      Echocardiography Coordinator
      Mt. Sinai Hospital
      Chicago, Illinois
    • a b
      Yes, it gave me pause for thought. Indication was current seizures. If one had been found, I suppose the method of delivery could be altered, and chances of
      Message 2 of 8 , Mar 2, 2006
      • 0 Attachment
        Yes, it gave me pause for thought.  Indication was current seizures.  If one had been found, I suppose the method of delivery could be altered, and chances of an event are probably very small, but I'm gun-shy with someone pregnant.  Heart looked normal, no shunt found, by the way, however reliable a TTE w/ saline is alone.  Would they put her through closure of the shunt while pregnant?

        Gerson Lichtenberg <gersonsl@...> wrote:
        I think that the first question actually is, "What do
        we need to know about this woman while she is still
        pregnant?" If it can wait until after delivery you
        should do so. If the shunt is small enough that the
        right heart is not enlarged, there is no paradoxic
        septal motion, and there are no systemic emboli, it
        does not seem that there is an immediate need for a
        contrast study.

        If there is concern for a large shunt or a small shunt
        with cardiac involvement as an embolic source, then a
        TEE might be appropriate. This way you assess the
        large ASD for closure or detect the small shunt so
        that the embolic issue can be addressed. Either way,
        you can probably wait until after delivery for a
        trans-thoracic echo with contrast.

        Gerson Lichtenberg, RDCS, APS
        Echo Lab Coordinator
        Mt. Sinai Hospital
        Chicago, Illinois

        --- a b wrote:

        > Anyone know the safety guidelines regarding bubble
        > studies for atrial shunting on pregnant women?
        >
        >
        > ---------------------------------
        > Yahoo! Mail
        > Use Photomail to share photos without annoying
        attachments.


        Gerson Lichtenberg, RDCS, APS
        Echocardiography Coordinator
        Mt. Sinai Hospital
        Chicago, Illinois



        Yahoo! Groups Links

        <*> To visit your group on the web, go to:
        http://groups.yahoo.com/group/echocardiography/

        <*> To unsubscribe from this group, send an email to:
        echocardiography-unsubscribe@yahoogroups.com

        <*> Your use of Yahoo! Groups is subject to:
        http://docs.yahoo.com/info/terms/





        Yahoo! Mail
        Bring photos to life! New PhotoMail makes sharing a breeze.

      • Gerson Lichtenberg
        Probably not, but the question becomes will she be able to complete the pregnancy? If the pregnancy itself is judged to be a threat to the mother s life, then
        Message 3 of 8 , Mar 3, 2006
        • 0 Attachment
          Probably not, but the question becomes will she be
          able to complete the pregnancy? If the pregnancy
          itself is judged to be a threat to the mother's life,
          then it might be terminated so that the repair can be
          done. I have not yet seen this happen, although we
          have had 3 pregnant women with definite ASD's in the
          past year.

          We are in the situation where these are people who are
          on public aid, so it is imporant to get the diagnosis
          and treatment completed before the aid runs out.

          Gerson Lichtenberg, RDCS, APS
          Echo Lab Coordinator
          Mt. Sinai Hospital
          Chicago, Illinois

          --- a b <ginalulubaby@...> wrote:

          > Yes, it gave me pause for thought. Indication was
          > current seizures. If one had been found, I suppose
          > the method of delivery could be altered, and chances
          > of an event are probably very small, but I'm gun-shy
          > with someone pregnant. Heart looked normal, no
          > shunt found, by the way, however reliable a TTE w/
          > saline is alone. Would they put her through closure
          > of the shunt while pregnant?
          >
          > Gerson Lichtenberg <gersonsl@...> wrote:
          > I think that the first question actually is, "What
          > do
          > we need to know about this woman while she is still
          > pregnant?" If it can wait until after delivery you
          > should do so. If the shunt is small enough that the
          > right heart is not enlarged, there is no paradoxic
          > septal motion, and there are no systemic emboli, it
          > does not seem that there is an immediate need for a
          > contrast study.
          >
          > If there is concern for a large shunt or a small
          > shunt
          > with cardiac involvement as an embolic source, then
          > a
          > TEE might be appropriate. This way you assess the
          > large ASD for closure or detect the small shunt so
          > that the embolic issue can be addressed. Either way,
          > you can probably wait until after delivery for a
          > trans-thoracic echo with contrast.
          >
          > Gerson Lichtenberg, RDCS, APS
          > Echo Lab Coordinator
          > Mt. Sinai Hospital
          > Chicago, Illinois
          >
          > --- a b wrote:
          >
          > > Anyone know the safety guidelines regarding bubble
          > > studies for atrial shunting on pregnant women?
          > >
          > >
          > > ---------------------------------
          > > Yahoo! Mail
          > > Use Photomail to share photos without annoying
          > attachments.
          >
          >
          > Gerson Lichtenberg, RDCS, APS
          > Echocardiography Coordinator
          > Mt. Sinai Hospital
          > Chicago, Illinois
          >
          >
          >
          > Yahoo! Groups Links
          >
          >
          >
          >
          >
          >
          >
          >
          >
          > ---------------------------------
          > Yahoo! Mail
          > Bring photos to life! New PhotoMail makes sharing a
          > breeze.


          Gerson Lichtenberg, RDCS, APS
          Echocardiography Coordinator
          Mt. Sinai Hospital
          Chicago, Illinois
        • Ger F
          A side note on detection of PFO......... Thanigarj et al in AJC 2005 96 1007-1010...... Turns out a TTE with bubble injection following Valsalva release is
          Message 4 of 8 , Mar 3, 2006
          • 0 Attachment
            A side note on detection of PFO.........

            Thanigarj et al in AJC 2005 96 1007-1010......

            Turns out a TTE with bubble injection following
            Valsalva release is quite sensitive compared to TEE.

            In our TEE exams, pts are sedated and can not
            voluntarily change their loading conditions with
            Valsalva.

            Would be interested in the experience of other labs

            Ger

            --- Gerson Lichtenberg <gersonsl@...> wrote:

            > Probably not, but the question becomes will she be
            > able to complete the pregnancy? If the pregnancy
            > itself is judged to be a threat to the mother's
            > life,
            > then it might be terminated so that the repair can
            > be
            > done. I have not yet seen this happen, although we
            > have had 3 pregnant women with definite ASD's in the
            > past year.
            >
            > We are in the situation where these are people who
            > are
            > on public aid, so it is imporant to get the
            > diagnosis
            > and treatment completed before the aid runs out.
            >
            > Gerson Lichtenberg, RDCS, APS
            > Echo Lab Coordinator
            > Mt. Sinai Hospital
            > Chicago, Illinois
            >
            > --- a b <ginalulubaby@...> wrote:
            >
            > > Yes, it gave me pause for thought. Indication was
            > > current seizures. If one had been found, I
            > suppose
            > > the method of delivery could be altered, and
            > chances
            > > of an event are probably very small, but I'm
            > gun-shy
            > > with someone pregnant. Heart looked normal, no
            > > shunt found, by the way, however reliable a TTE w/
            > > saline is alone. Would they put her through
            > closure
            > > of the shunt while pregnant?
            > >
            > > Gerson Lichtenberg <gersonsl@...> wrote:
            >
            > > I think that the first question actually is, "What
            > > do
            > > we need to know about this woman while she is
            > still
            > > pregnant?" If it can wait until after delivery you
            > > should do so. If the shunt is small enough that
            > the
            > > right heart is not enlarged, there is no paradoxic
            > > septal motion, and there are no systemic emboli,
            > it
            > > does not seem that there is an immediate need for
            > a
            > > contrast study.
            > >
            > > If there is concern for a large shunt or a small
            > > shunt
            > > with cardiac involvement as an embolic source,
            > then
            > > a
            > > TEE might be appropriate. This way you assess the
            > > large ASD for closure or detect the small shunt so
            > > that the embolic issue can be addressed. Either
            > way,
            > > you can probably wait until after delivery for a
            > > trans-thoracic echo with contrast.
            > >
            > > Gerson Lichtenberg, RDCS, APS
            > > Echo Lab Coordinator
            > > Mt. Sinai Hospital
            > > Chicago, Illinois
            > >
            > > --- a b wrote:
            > >
            > > > Anyone know the safety guidelines regarding
            > bubble
            > > > studies for atrial shunting on pregnant women?
            > > >
            > > >
            > > > ---------------------------------
            > > > Yahoo! Mail
            > > > Use Photomail to share photos without annoying
            > > attachments.
            > >
            > >
            > > Gerson Lichtenberg, RDCS, APS
            > > Echocardiography Coordinator
            > > Mt. Sinai Hospital
            > > Chicago, Illinois
            > >
            > >
            > >
            > > Yahoo! Groups Links
            > >
            > >
            > >
            > >
            > >
            > >
            > >
            > >
            > >
            > > ---------------------------------
            > > Yahoo! Mail
            > > Bring photos to life! New PhotoMail makes sharing
            > a
            > > breeze.
            >
            >
            > Gerson Lichtenberg, RDCS, APS
            > Echocardiography Coordinator
            > Mt. Sinai Hospital
            > Chicago, Illinois
            >
            >
            >
            > Yahoo! Groups Links
            >
            >
            > echocardiography-unsubscribe@yahoogroups.com
            >
            >
            >
            >
            >


            __________________________________________________
            Do You Yahoo!?
            Tired of spam? Yahoo! Mail has the best spam protection around
            http://mail.yahoo.com
          • Paolo Barbier
            We routinely perform TEE with bubble contrast and Valsalva since we prefer a mildly sedated and collaborative patient. Not much experience with TTE and
            Message 5 of 8 , Mar 4, 2006
            • 0 Attachment
              We routinely perform TEE with bubble contrast and Valsalva since we prefer
              a mildly sedated and collaborative patient.
              Not much experience with TTE and contrats for PFO

              Paolo Barbier



              At 07.02 03/03/2006 -0800, you wrote:
              >A side note on detection of PFO.........
              >
              >Thanigarj et al in AJC 2005 96 1007-1010......
              >
              >Turns out a TTE with bubble injection following
              >Valsalva release is quite sensitive compared to TEE.
              >
              >In our TEE exams, pts are sedated and can not
              >voluntarily change their loading conditions with
              >Valsalva.
              >
              >Would be interested in the experience of other labs
              >
              >Ger
              >
              >--- Gerson Lichtenberg <gersonsl@...> wrote:
              >
              > > Probably not, but the question becomes will she be
              > > able to complete the pregnancy? If the pregnancy
              > > itself is judged to be a threat to the mother's
              > > life,
              > > then it might be terminated so that the repair can
              > > be
              > > done. I have not yet seen this happen, although we
              > > have had 3 pregnant women with definite ASD's in the
              > > past year.
              > >
              > > We are in the situation where these are people who
              > > are
              > > on public aid, so it is imporant to get the
              > > diagnosis
              > > and treatment completed before the aid runs out.
              > >
              > > Gerson Lichtenberg, RDCS, APS
              > > Echo Lab Coordinator
              > > Mt. Sinai Hospital
              > > Chicago, Illinois
              > >
              > > --- a b <ginalulubaby@...> wrote:
              > >
              > > > Yes, it gave me pause for thought. Indication was
              > > > current seizures. If one had been found, I
              > > suppose
              > > > the method of delivery could be altered, and
              > > chances
              > > > of an event are probably very small, but I'm
              > > gun-shy
              > > > with someone pregnant. Heart looked normal, no
              > > > shunt found, by the way, however reliable a TTE w/
              > > > saline is alone. Would they put her through
              > > closure
              > > > of the shunt while pregnant?
              > > >
              > > > Gerson Lichtenberg <gersonsl@...> wrote:
              > >
              > > > I think that the first question actually is, "What
              > > > do
              > > > we need to know about this woman while she is
              > > still
              > > > pregnant?" If it can wait until after delivery you
              > > > should do so. If the shunt is small enough that
              > > the
              > > > right heart is not enlarged, there is no paradoxic
              > > > septal motion, and there are no systemic emboli,
              > > it
              > > > does not seem that there is an immediate need for
              > > a
              > > > contrast study.
              > > >
              > > > If there is concern for a large shunt or a small
              > > > shunt
              > > > with cardiac involvement as an embolic source,
              > > then
              > > > a
              > > > TEE might be appropriate. This way you assess the
              > > > large ASD for closure or detect the small shunt so
              > > > that the embolic issue can be addressed. Either
              > > way,
              > > > you can probably wait until after delivery for a
              > > > trans-thoracic echo with contrast.
              > > >
              > > > Gerson Lichtenberg, RDCS, APS
              > > > Echo Lab Coordinator
              > > > Mt. Sinai Hospital
              > > > Chicago, Illinois
              > > >
              > > > --- a b wrote:
              > > >
              > > > > Anyone know the safety guidelines regarding
              > > bubble
              > > > > studies for atrial shunting on pregnant women?
              > > > >
              > > > >
              > > > > ---------------------------------
              > > > > Yahoo! Mail
              > > > > Use Photomail to share photos without annoying
              > > > attachments.
              > > >
              > > >
              > > > Gerson Lichtenberg, RDCS, APS
              > > > Echocardiography Coordinator
              > > > Mt. Sinai Hospital
              > > > Chicago, Illinois
              > > >
              > > >
              > > >
              > > > Yahoo! Groups Links
              > > >
              > > >
              > > >
              > > >
              > > >
              > > >
              > > >
              > > >
              > > >
              > > > ---------------------------------
              > > > Yahoo! Mail
              > > > Bring photos to life! New PhotoMail makes sharing
              > > a
              > > > breeze.
              > >
              > >
              > > Gerson Lichtenberg, RDCS, APS
              > > Echocardiography Coordinator
              > > Mt. Sinai Hospital
              > > Chicago, Illinois
              > >
              > >
              > >
              > > Yahoo! Groups Links
              > >
              > >
              > > echocardiography-unsubscribe@yahoogroups.com
              > >
              > >
              > >
              > >
              > >
              >
              >
              >__________________________________________________
              >Do You Yahoo!?
              >Tired of spam? Yahoo! Mail has the best spam protection around
              >http://mail.yahoo.com
              >
              >
              >
              >Yahoo! Groups Links
              >
              >
              >
              >

              _________________________________________
              Dr. Paolo Barbier,
              Centro Cardiologico Monzino, IRCCS
              20138 Milano, Italy
              Tel: +39 02 58002.567 - Fax: +39 02 504667
              Cell.:+39 338 9600928
              email: pbar@...
              sito web: http://www.echobyweb.com
            • Andrew Mitchell
              Percutaneous PFO / ASD closure can easily be performed in pregnancy. Using intracardiac echo the radiation dose is negligible. We usually wait until 16/17
              Message 6 of 8 , Mar 5, 2006
              • 0 Attachment
                Percutaneous PFO / ASD closure can easily be performed in pregnancy. Using
                intracardiac echo the radiation dose is negligible. We usually wait until
                16/17 weeks before performing the procedure.

                Dr Andrew RJ Mitchell MD MRCP FESC
                John Radcliffe Hospital
                Oxford
                 
                -----Original Message-----
                From: echocardiography@yahoogroups.com
                [mailto:echocardiography@yahoogroups.com] On Behalf Of Gerson Lichtenberg
                Sent: 03 March 2006 13:38
                To: echocardiography@yahoogroups.com
                Subject: Re: [echocardiography] Pregnancy & saline contrast

                Probably not, but the question becomes will she be
                able to complete the pregnancy? If the pregnancy
                itself is judged to be a threat to the mother's life,
                then it might be terminated so that the repair can be
                done. I have not yet seen this happen, although we
                have had 3 pregnant women with definite ASD's in the
                past year.

                We are in the situation where these are people who are
                on public aid, so it is imporant to get the diagnosis
                and treatment completed before the aid runs out.

                Gerson Lichtenberg, RDCS, APS
                Echo Lab Coordinator
                Mt. Sinai Hospital
                Chicago, Illinois

                --- a b <ginalulubaby@...> wrote:

                > Yes, it gave me pause for thought. Indication was
                > current seizures. If one had been found, I suppose
                > the method of delivery could be altered, and chances
                > of an event are probably very small, but I'm gun-shy
                > with someone pregnant. Heart looked normal, no
                > shunt found, by the way, however reliable a TTE w/
                > saline is alone. Would they put her through closure
                > of the shunt while pregnant?
                >
                > Gerson Lichtenberg <gersonsl@...> wrote:
                > I think that the first question actually is, "What
                > do
                > we need to know about this woman while she is still
                > pregnant?" If it can wait until after delivery you
                > should do so. If the shunt is small enough that the
                > right heart is not enlarged, there is no paradoxic
                > septal motion, and there are no systemic emboli, it
                > does not seem that there is an immediate need for a
                > contrast study.
                >
                > If there is concern for a large shunt or a small
                > shunt
                > with cardiac involvement as an embolic source, then
                > a
                > TEE might be appropriate. This way you assess the
                > large ASD for closure or detect the small shunt so
                > that the embolic issue can be addressed. Either way,
                > you can probably wait until after delivery for a
                > trans-thoracic echo with contrast.
                >
                > Gerson Lichtenberg, RDCS, APS
                > Echo Lab Coordinator
                > Mt. Sinai Hospital
                > Chicago, Illinois
                >
                > --- a b wrote:
                >
                > > Anyone know the safety guidelines regarding bubble
                > > studies for atrial shunting on pregnant women?
                > >
                > >
                > > ---------------------------------
                > > Yahoo! Mail
                > > Use Photomail to share photos without annoying
                > attachments.
                >
                >
                > Gerson Lichtenberg, RDCS, APS
                > Echocardiography Coordinator
                > Mt. Sinai Hospital
                > Chicago, Illinois
                >
                >
                >
                > Yahoo! Groups Links
                >
                >
                >
                >
                >
                >
                >
                >
                >
                > ---------------------------------
                > Yahoo! Mail
                > Bring photos to life! New PhotoMail makes sharing a
                > breeze.


                Gerson Lichtenberg, RDCS, APS
                Echocardiography Coordinator
                Mt. Sinai Hospital
                Chicago, Illinois



                Yahoo! Groups Links
              Your message has been successfully submitted and would be delivered to recipients shortly.