Key result
Cardiac interventions using low-dose radiation protocols in pregnant women resulted in a median radiation dose to the uterus of 0.73 mGy, significantly lower than in postpartum and prepregnancy women.
Why the study?
Does a low-radiation protocol reduce maternal and fetal ionizing radiation exposure during cardiac interventions in pregnant women?
Observational (n=28)
No
Does a low-radiation protocol reduce maternal and fetal ionizing radiation exposure during cardiac interventions in pregnant women?
Absolute Event Rate: 0.73% vs 5.21%
p-value: p=<0.01
Cardiac interventions can be performed safely in pregnant women using specific protocols to minimize ionizing radiation, resulting in extremely low fetal exposure.
May support low-radiation cardiac interventions in pregnancy; leaves open prospective validation of fetal outcomes.
BACKGROUND: There is concern over ionizing radiation exposure in women who are pregnant or of child-bearing age. Due to the increasing prevalence of congenital and acquired heart disease, the number of women who require cardiac interventions during pregnancy has increased. We have developed protocols for cardiac interventions in pregnant women and women of child-bearing age, aimed at substantially reducing both fluoroscopy duration and radiation doses. METHODS: Over five years, we performed cardiac interventions on 15 pregnant women, nine postpartum women and four as part of prepregnancy assessment. Fluoroscopy times were minimized by simultaneous use of intracardiac echocardiography, and by using very low frame rates (2/second) during fluoroscopy. RESULTS: The procedures most commonly undertaken were closure of atrial septal defect (ASD) or patent foramen ovale (PFO) in 16 women, coronary angiograms in seven, right and left heart catheters in three and two stent placements. The mean screening time for all patients was 2.38 minutes (range 0.48-13.7), the median radiation dose was 66 (8.9-1501) Gy/cm(2). The median radiation dose to uterus was 1.92 (0.59-5.47) μGy, and the patient estimated dose was 0.24 (0.095-0.80) mSv. CONCLUSIONS: Ionizing radiation can be used safely in the management of severe cardiac structural disease in pregnancy, with very low ionizing radiation dose to the mother and extremely low exposure to the fetus. With experience, ionizing radiation doses at our institution have been reduced.
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Orchard et al. (2012) conducted an observational in Severe cardiac structural disease requiring catheterization (n=28). Low-dose radiation protocols for cardiac interventions vs. Postpartum and prepregnancy women was evaluated on Median radiation dose to uterus (mGy) (p=<0.01). Cardiac interventions using low-dose radiation protocols in pregnant women resulted in a median radiation dose to the uterus of 0.73 mGy, significantly lower than in postpartum and prepregnancy women.
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