Erin S Mackinnon, Bryan Har, Salimah Champsi, Rajvi J Wani, Lee Geyer, Eileen Shaw, Megan S Farris, Todd J Anderson
{"title":"Correction to: Guideline LDL-C Threshold Achievement in Acute Myocardial Infarction Patients: A Real-World Evidence Study Demonstrating the Impact of Treatment Intensification with PCSK9i.","authors":"Erin S Mackinnon, Bryan Har, Salimah Champsi, Rajvi J Wani, Lee Geyer, Eileen Shaw, Megan S Farris, Todd J Anderson","doi":"10.1007/s40119-023-00310-z","DOIUrl":"https://doi.org/10.1007/s40119-023-00310-z","url":null,"abstract":"","PeriodicalId":9561,"journal":{"name":"Cardiology and Therapy","volume":"12 2","pages":"339"},"PeriodicalIF":3.4,"publicationDate":"2023-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/ad/55/40119_2023_Article_310.PMC10209353.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9525695","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Cardiology and TherapyPub Date : 2023-06-01Epub Date: 2023-02-09DOI: 10.1007/s40119-023-00305-w
Loreena Hill, Bruno Delgado, Ekaterini Lambrinou, Tara Mannion, Mark Harbinson, Claire McCune
{"title":"Risk and Management of Patients with Cancer and Heart Disease.","authors":"Loreena Hill, Bruno Delgado, Ekaterini Lambrinou, Tara Mannion, Mark Harbinson, Claire McCune","doi":"10.1007/s40119-023-00305-w","DOIUrl":"10.1007/s40119-023-00305-w","url":null,"abstract":"<p><p>Cancer and cardiovascular disease are two of the leading causes of global mortality and morbidity. Medical research has generated powerful lifesaving treatments for patients with cancer; however, such treatments may sometimes be at the expense of the patient's myocardium, leading to heart failure. Anti-cancer drugs, including anthracyclines, can result in deleterious cardiac effects, significantly impacting patients' functional capacity, mental well-being, and quality of life. Recognizing this, recent international guidelines and expert papers published recommendations on risk stratification and care delivery, including that of cardio-oncology services. This review will summarize key evidence with a focus on anthracycline therapy, providing clinical guidance for the non-oncology professional caring for a patient with cancer and heart failure.</p>","PeriodicalId":9561,"journal":{"name":"Cardiology and Therapy","volume":"12 2","pages":"227-241"},"PeriodicalIF":3.4,"publicationDate":"2023-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/25/36/40119_2023_Article_305.PMC10209380.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9790287","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Circadian Factors in Stroke: A Clinician's Perspective.","authors":"Lyudmila S Korostovtseva, Sergey N Kolomeichuk","doi":"10.1007/s40119-023-00313-w","DOIUrl":"https://doi.org/10.1007/s40119-023-00313-w","url":null,"abstract":"<p><p>Stroke remains one of the leading causes of mortality and long-term and permanent disability worldwide despite technological innovations and developments in pharmacotherapy. In the last few decades, the growing data have evidenced the role of the circadian system in brain vulnerability to damage, the development and evolution of stroke, and short-term and long-term recovery. On the other hand, the stroke itself can affect the circadian system via direct injury of specific brain structures involved in circadian regulation (i.e., hypothalamus, retinohypothalamic tracts, etc.) and impairment of endogenous regulatory mechanisms, metabolic derangement, and a neurogenic inflammatory response in acute stroke. Moreover, the disruption of circadian rhythms can occur or exacerbate as a result of exogenous factors related to hospitalization itself, the conditions in the intensive care unit and the ward (light, noise, etc.), medication (sedatives and hypnotics), and loss of external factors entraining the circadian rhythms. In the acute phase of stroke, patients demonstrate abnormal circadian variations in circadian biomarkers (melatonin, cortisol), core body temperature, and rest-activity patterns. The approaches aimed at the restoration of disrupted circadian patterns include pharmacological (melatonin supplementation) and non-medication (bright light therapy, shifting feeding schedules, etc.) interventions; however, their effects on short- and long-term recovery after stroke are not well understood.</p>","PeriodicalId":9561,"journal":{"name":"Cardiology and Therapy","volume":"12 2","pages":"275-295"},"PeriodicalIF":3.4,"publicationDate":"2023-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/59/59/40119_2023_Article_313.PMC10209385.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10169327","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Giuseppe Patti, Rosa Wang, Xiaocong Li Marston, Yu-Chen Yeh, Lisa Zimmermann, Xin Ye, Xin Gao, Bernd Brüggenjürgen
{"title":"Anticoagulant Treatment Adherence and Persistence in German Patients with Atrial Fibrillation.","authors":"Giuseppe Patti, Rosa Wang, Xiaocong Li Marston, Yu-Chen Yeh, Lisa Zimmermann, Xin Ye, Xin Gao, Bernd Brüggenjürgen","doi":"10.1007/s40119-023-00315-8","DOIUrl":"https://doi.org/10.1007/s40119-023-00315-8","url":null,"abstract":"<p><strong>Introduction: </strong>Treatment adherence and persistence impact the effectiveness of edoxaban for the prevention of thromboembolism in patients with atrial fibrillation (AF). The objective of this analysis was to assess adherence and persistence of edoxaban vs. other non-vitamin K antagonist oral anticoagulants (NOACs) and vitamin K antagonists (VKAs).</p><p><strong>Methods: </strong>Utilizing a German claims database, adults with AF with the first pharmacy claim identified for edoxaban, apixaban, dabigatran, rivaroxaban, or VKAs from January 2013 to December 2017 were included in a propensity score-matched analysis. The first pharmacy claim was the index claim. Adherence (i.e., proportion of days covered [PDC]) and persistence (proportion of patients who continued therapy) were compared between edoxaban and other therapies. Patients receiving once-daily (QD) vs. twice-daily (BID) NOAC were also analyzed.</p><p><strong>Results: </strong>Overall, 21,038 patients were included (1236 edoxaban, 6053 apixaban, 1306 dabigatran, 7013 rivaroxaban, and 5430 VKA). After matching, baseline characteristics were well balanced across cohorts. Adherence was significantly higher for edoxaban vs. apixaban, dabigatran, and VKAs (all P < 0.0001). Significantly more edoxaban patients continued therapy vs. rivaroxaban (P = 0.0153), dabigatran (P < 0.0001), and VKAs (P < 0.0001). Time to discontinuation was significantly longer for edoxaban vs. dabigatran, rivaroxaban, and VKAs (all P < 0.0001). More patients receiving NOACs QD had a PDC ≥ 0.8 compared with those receiving NOACs BID (65.3 vs. 49.6%, respectively; P < 0.05); persistence rates were comparable between QD and BID groups.</p><p><strong>Conclusions: </strong>Patients with AF receiving edoxaban had significantly higher adherence and persistence compared with those receiving VKAs. This trend was also seen in NOAC QD regimens vs. NOAC BID regimens for adherence. These results provide insight into how adherence and persistence may contribute to the effectiveness of edoxaban for stroke prevention in patients with AF in Germany.</p>","PeriodicalId":9561,"journal":{"name":"Cardiology and Therapy","volume":"12 2","pages":"371-391"},"PeriodicalIF":3.4,"publicationDate":"2023-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/79/40/40119_2023_Article_315.PMC10209377.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10210977","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"One-Year Healthcare Utilization and Expenditures Among Patients with Clinically Significant Mitral Regurgitation in Taiwan.","authors":"Ching-Hu Chung, Yu-Jen Wang, Chia-Ying Lee","doi":"10.1007/s40119-022-00294-2","DOIUrl":"https://doi.org/10.1007/s40119-022-00294-2","url":null,"abstract":"<p><strong>Introduction: </strong>Mitral regurgitation (MR) is characterized by systolic blood flow reversal from the left ventricle to the left atrium. A 2019 study indicated that in the USA, clinically significant MR (sMR) is associated with a substantial healthcare cost burden. In Taiwan, few data are available to describe the clinical characteristics, treatment patterns, and economic burden of patients with sMR.</p><p><strong>Methods: </strong>Using the National Health Insurance Research Database (NHIRD), a national, detailed claims database of all 23 million residents of Taiwan, we conducted a retrospective cohort study to identify patients with sMR and quantify the impact of the disease on Taiwan's healthcare system. We classified patients with sMR into three cohorts based on disease etiology: functional MR (sFMR), degenerative MR (sDMR), and uncharacterized MR (sUMR).</p><p><strong>Results: </strong>We compared patient characteristics across cohorts and estimated attributable healthcare utilization and costs during the 12-month follow-up period. Our research shows that in Taiwan, patients with sFMR were older, sicker, and presented at casualty (emergency department) more frequently than those with sDMR and sUMR. Meanwhile, patients with sDMR had the highest 12-month healthcare expenditures across the cohorts.</p><p><strong>Conclusion: </strong>These findings are inconsistent with what has been shown in the USA, which warrants further investigation.</p>","PeriodicalId":9561,"journal":{"name":"Cardiology and Therapy","volume":"12 1","pages":"159-169"},"PeriodicalIF":3.4,"publicationDate":"2023-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/c7/d4/40119_2022_Article_294.PMC9986361.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10111830","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Cardiology and TherapyPub Date : 2023-03-01Epub Date: 2022-12-25DOI: 10.1007/s40119-022-00293-3
Justin K Ugwu, Daniel R Kandah, Jideofor K Ndulue, Okechukwu P Ebiem, Judith N Ugwu-Erugo, Russell Hamilton, Kofi Osei, Tuncay Taskesen, Daniel M Shivapour, Atul Chawla, Richard H Marcus
{"title":"Comparative Outcomes of TAVR in Mixed Aortic Valve Disease and Aortic Stenosis: A Meta-analysis.","authors":"Justin K Ugwu, Daniel R Kandah, Jideofor K Ndulue, Okechukwu P Ebiem, Judith N Ugwu-Erugo, Russell Hamilton, Kofi Osei, Tuncay Taskesen, Daniel M Shivapour, Atul Chawla, Richard H Marcus","doi":"10.1007/s40119-022-00293-3","DOIUrl":"10.1007/s40119-022-00293-3","url":null,"abstract":"<p><strong>Introduction: </strong>Transcatheter aortic valve replacement (TAVR) has become a suitable alternative to surgical aortic valve replacement (SAVR) for the treatment of symptomatic severe aortic stenosis (AS). A high proportion of patients with AS have mixed aortic valve disease (MAVD) with mild or more concurrent aortic regurgitation (AR). Differential outcomes of TAVR among patients with AS and MAVD have not been well characterized. We compared 1-year mortalities following TAVR among patients with MAVD and AS.</p><p><strong>Methods: </strong>We conducted a meta-analysis of studies published in PubMed/Medline. The primary outcome was 1-year all-cause mortality following TAVR among patients with MAVD vs. AS. Secondary endpoints were: (1) incidence of AR within 30 days following TAVR (post TAVR AR); and (2) 1-year all-cause mortality within each group stratified according to severity of post TAVR AR.</p><p><strong>Results: </strong>Nine studies involving 9505 participants were included in the analysis. At 1 year following TAVR, mortality was lower in MAVD than in AS; HR 0.89, 95% CI 0.81-0.98. The mortality advantage increased when pre-TAVR AR was moderate or more; HR 0.84, 95% CI 0.72-0.99. The mortality advantage was attenuated after correction for publication bias. There was a higher risk of post TAVR AR in the MAVD group; OR 1.51, 95% CI 1.20-1.90 but the impact on mortality of moderate vs. mild post TAVR AR was greater among patients with AS than in patients with MAVD HR 1.67 95% CI 0.89-3.14 vs. 0.93 95% CI 0.47-1.85.</p><p><strong>Conclusions: </strong>Patients with MAVD have similar or improved survival 1 year after TAVR compared to those with AS.</p>","PeriodicalId":9561,"journal":{"name":"Cardiology and Therapy","volume":"12 1","pages":"143-157"},"PeriodicalIF":3.0,"publicationDate":"2023-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/a0/20/40119_2022_Article_293.PMC9986165.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9750008","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Melika Farshidianfar, Ali Ardekani, Reza Tabrizi, Kamran B Lankarani, Erfan Taherifard, Ashkan Abdollahi, Arezou Azizi, Maryam Akbari
{"title":"Effects of Melatonin on Cardiac Injury and Inflammatory Biomarkers in Patients Undergoing Coronary Artery Bypass Graft Surgery: a Meta-analysis.","authors":"Melika Farshidianfar, Ali Ardekani, Reza Tabrizi, Kamran B Lankarani, Erfan Taherifard, Ashkan Abdollahi, Arezou Azizi, Maryam Akbari","doi":"10.1007/s40119-022-00287-1","DOIUrl":"https://doi.org/10.1007/s40119-022-00287-1","url":null,"abstract":"<p><strong>Introduction: </strong>The antiinflammatory and antioxidative effects of melatonin have been established in recent years. Several studies indicate that oxidative stress and inflammation are key drivers of post-coronary artery bypass graft (CABG) surgery complications. In the present study, we aimed to investigate the effects of melatonin on cardiac injury and inflammatory biomarkers in CABG candidates.</p><p><strong>Methods: </strong>Embase, Medline/PubMed, Web of Science, Scopus, and the Cochrane library were searched up to 5 June 2022. All randomized controlled trials examining cardiac injury and inflammatory biomarkers of CABG patients who received melatonin were included. The random-effects model was utilized to perform the analysis.</p><p><strong>Results: </strong>A total of 947 citations were retrieved through database searches. Finally, five articles (six trials with 342 patients) were included after the screening. Melatonin supplementation led to a significant reduction in cardiac troponin I (CTnI) [weighted mean difference(WMD): -2.28 ng/ml; 95% CI -2.87, -1.69; P < 0.01; I<sup>2</sup>: 91.25%] and high sensitivity-C reactive protein (hs-CRP) levels (WMD: -0.62 mg/L; 95% CI -0.73, -0.5; P < 0.01; I<sup>2</sup>: 99.98%) in patients undergoing CABG surgery. We found a nonsignificant decrease in creatine kinase isoenzyme muscle/brain (CK-MB) levels (WMD: -2.87 ng/ml; 95% CI -5.97, 0.23; P = 0.07; I<sup>2</sup>: 99.98%) after melatonin supplementation. No publication bias was found according to Egger's test.</p><p><strong>Conclusion: </strong>Melatonin supplementation may be useful in reducing cardiac injury and inflammatory biomarkers in CABG candidates. Future studies should investigate the clinical significance of these findings.</p>","PeriodicalId":9561,"journal":{"name":"Cardiology and Therapy","volume":"12 1","pages":"11-20"},"PeriodicalIF":3.4,"publicationDate":"2023-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/71/20/40119_2022_Article_287.PMC9986370.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9753221","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Cardiology and TherapyPub Date : 2023-03-01Epub Date: 2022-12-08DOI: 10.1007/s40119-022-00290-6
Miki Imura, Tsunehisa Yamamoto, Ken-Ichi Hiasa
{"title":"Pulmonary Thromboembolism Developed During Hospitalization: A Nationwide Retrospective Observational Study Using Claims Data.","authors":"Miki Imura, Tsunehisa Yamamoto, Ken-Ichi Hiasa","doi":"10.1007/s40119-022-00290-6","DOIUrl":"10.1007/s40119-022-00290-6","url":null,"abstract":"<p><strong>Introduction: </strong>Evidence regarding the development of pulmonary thromboembolism (PE) during hospitalization is unclear. We hypothesized that the incidence of PE could vary depending on clinical department and aimed to conduct a survey on the incidence of in-hospital PE.</p><p><strong>Methods: </strong>We conducted a retrospective analysis using claims data of in-hospital patients in Japan. We collected background information regarding patients with and without PE occurrence during hospitalization. Further, we determined the incidence of PE and implemented prophylactic procedures in patients with and without surgery according to clinical department at admission. Finally, we examined the duration of hospital stay and in-hospital mortality rates in patients with and without PE.</p><p><strong>Results: </strong>We found that 5007 (0.107%, 20.61 per 1000 person-years) patients developed PE during hospitalization and differed by clinical department at admission. Moreover, 2272 (0.095%, 19.3 per 1000 person-years) and 2735 (0.119%, 21.8 per 1000 person-years) patients with and without surgery, respectively, developed PE during hospitalization (P < 0.001). Further, 33.8% of inpatients underwent prophylactic procedures for PE; however, the implementation rate differed between patients with and without surgery (59.2% vs. 7.3%, P < 0.001). The median duration of hospital stay in patients with and without PE was 31.0 and 11.0 days, and the in-hospital mortality rates in patients with and without PE were 11.0% and 3.5%, respectively (P < 0.001).</p><p><strong>Discussion: </strong>The incidence of in-hospital PE differed according to patient characteristics, clinical departments, and presence/absence of surgery. The onset of PE during hospitalization leads to prolonged hospital stay and in-hospital death.</p><p><strong>Conclusion: </strong>It is important to conduct a proper risk assessment on admission as well as to implement proper prophylactic procedures to prevent the development of PE during hospitalization.</p>","PeriodicalId":9561,"journal":{"name":"Cardiology and Therapy","volume":"12 1","pages":"127-141"},"PeriodicalIF":3.0,"publicationDate":"2023-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/6d/3c/40119_2022_Article_290.PMC9734681.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10829772","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Emerging PET Tracers in Cardiac Molecular Imaging.","authors":"Shashi Bhushan Singh, Sze Jia Ng, Hui Chong Lau, Kishor Khanal, Sanket Bhattarai, Pranita Paudyal, Bimash Babu Shrestha, Rizwan Naseer, Simran Sandhu, Saket Gokhale, William Y Raynor","doi":"10.1007/s40119-022-00295-1","DOIUrl":"https://doi.org/10.1007/s40119-022-00295-1","url":null,"abstract":"<p><p><sup>18</sup>F-fluorodeoxyglucose (FDG) and <sup>18</sup>F-sodium fluoride (NaF) represent emerging PET tracers used to assess atherosclerosis-related inflammation and molecular calcification, respectively. By localizing to sites with high glucose utilization, FDG has been used to assess myocardial viability for decades, and its role in evaluating cardiac sarcoidosis has come to represent a major application. In addition to determining late-stage changes such as loss of perfusion or viability, by targeting mechanisms present in atherosclerosis, PET-based techniques have the ability to characterize atherogenesis in the early stages to guide intervention. Although it was once thought that FDG would be a reliable indicator of ongoing plaque formation, micro-calcification as portrayed by NaF-PET/CT appears to be a superior method of monitoring disease progression. PET imaging with NaF has the additional advantage of being able to determine abnormal uptake due to coronary artery disease, which is obscured by physiologic myocardial activity on FDG-PET/CT. In this review, we discuss the evolving roles of FDG, NaF, and other PET tracers in cardiac molecular imaging.</p>","PeriodicalId":9561,"journal":{"name":"Cardiology and Therapy","volume":"12 1","pages":"85-99"},"PeriodicalIF":3.4,"publicationDate":"2023-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/3c/b7/40119_2022_Article_295.PMC9986170.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10129588","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Anticoagulation During Pregnancy with a Mechanical Pulmonary Valve: Patient and Medical Perspective.","authors":"Lauren Ledingham, Amanda Thiess, May Ling Mah","doi":"10.1007/s40119-022-00296-0","DOIUrl":"https://doi.org/10.1007/s40119-022-00296-0","url":null,"abstract":"<p><p>This article discusses the challenges of supporting a successful pregnancy in a woman with multiple prosthetic heart valves and a complicated cardiac history, from both the patient and provider perspective. The patient is a 29-year-old female with truncus arteriosus type I with initial neonatal VSD closure and right ventricular to pulmonary artery conduit. At the age of 13, she subsequently required truncal and pulmonary valve replacements with mechanical prostheses. Standardizing an approach to anticoagulation in pregnancy in women with prosthetic heart valves is not always possible. Her story demonstrates the importance of an innovative approach to unique cases; by extrapolating what is known about pregnancy and prosthetic heart valves, cardiologists can provide the best outcomes. Simultaneously, non-directive counseling is essential throughout this period to engage the patient in shared decision-making when balancing risks and benefits of each approach to anticoagulation.</p>","PeriodicalId":9561,"journal":{"name":"Cardiology and Therapy","volume":"12 1","pages":"1-5"},"PeriodicalIF":3.4,"publicationDate":"2023-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/8e/21/40119_2022_Article_296.PMC9986153.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9743418","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}