Publications by authors named "Cary Ward"

Article Synopsis
  • Improved survival rates after heart transplantation (HT) have led more recipients to consider pregnancy, but there is limited data on the associated outcomes.
  • In a study analyzing over 19 million deliveries in the U.S., HT recipients were found to have significantly higher risks for severe maternal morbidity (SMM), preterm birth, and readmission within one year after delivery compared to non-HT recipients.
  • The findings indicate that women with a history of HT face 16 to 38 times greater odds of suffering from various complications during and after pregnancy, highlighting the need for careful counseling for these patients.
View Article and Find Full Text PDF

Objective: N-terminal pro-brain natriuretic peptide (NT-proBNP), a marker of ventricular dysfunction, varies by body mass index (BMI) outside of pregnancy. This study aimed to determine whether obesity affects NT-proBNP levels in pregnancy.

Study Design: This was a prospective observational study of healthy pregnant people in the third trimester (3TM) and postpartum (PP).

View Article and Find Full Text PDF
Article Synopsis
  • * The field of cardio-obstetrics focuses on managing women with or at high risk for heart disease related to pregnancy, highlighting the need for more specialists with this expertise.
  • * Proposed specialized training pathways for cardiovascular fellows are aimed at filling knowledge gaps and preparing healthcare providers to better care for women with cardiovascular issues throughout the pregnancy journey.
View Article and Find Full Text PDF
Article Synopsis
  • Women with congenital heart disease (CHD) have a higher prevalence of hypertensive disorders of pregnancy (HDP) compared to those without CHD, with rates of 11.2% vs 8.1% respectively.
  • Chronic hypertension and diabetes mellitus are significant risk factors for HDP in women with CHD, along with coarctation of the aorta as a specific condition linked to increased risk.
  • HDP was found to be more strongly associated with complications like difficult deliveries and preterm births, indicating that HDP poses more substantial risks than the presence of CHD itself.
View Article and Find Full Text PDF
Article Synopsis
  • * A review found 14 cases of aortic dissection linked to pregnancy in women with TS, mainly during pregnancy or shortly after childbirth, with a notable number involving oocyte donation.
  • * Women with TS seeking pregnancy need thorough counseling on these risks and should undergo careful monitoring by various specialists throughout the process to ensure their safety.
View Article and Find Full Text PDF

Survivorship into adulthood of patients with congenital heart disease is due to improvements in prenatal detection, novel surgeries, and specialized adult congenital heart disease care. As patients survive further into adulthood, long-term complications of congenital and repaired physiology have been more clearly elucidated. The overall mortality of patients with adult congenital heart disease with heart failure is around 4%.

View Article and Find Full Text PDF
Article Synopsis
  • Heart failure affects 6.2 million adults in the U.S., with current treatments focused on symptom management and disease progression, highlighting the importance of integrating palliative care (PC).
  • A study involving 60 heart failure patients showed that those who received PC education were more likely to request PC consultations compared to those who did not receive the education.
  • While PC education increased consultation requests, it did not significantly affect outcomes like readmissions, mortality, or ICU transfers in the short term.
View Article and Find Full Text PDF

Background: Health systems often employ interruptive alerts through the electronic health record to improve patient care. However, concerns of "alert fatigue" have been raised, highlighting the importance of understanding the time burden and impact of these alerts on providers.

Objectives: Our main objective was to determine the total time providers spent on interruptive alerts in both inpatient and outpatient settings.

View Article and Find Full Text PDF

Objective: Congenital heart defects represent the most common major congenital anomalies. The objective of this review was to define the most common forms of congenital heart disease (CHD) in pregnancy, outline preconception counseling, discuss the associated morbidity and mortality of each lesion, and review current recommendations for management of CHD in pregnancy.

Evidence Acquisition: A MEDLINE search of "congenital heart disease in pregnancy" and specific conditions in pregnancy including "ventricular septal defect," "atrial septal defect," "left outflow obstruction," "right outflow obstruction," "tetralogy of Fallot," and "transposition of the great vessels" was performed.

View Article and Find Full Text PDF

Some congenital heart diseases (CHDs) and inherited arrhythmia syndromes are associated with an increased risk of sudden cardiac death (SCD). Appropriate selection criteria for implantable cardioverter-defibrillator (ICD) implantation in these patients are poorly defined due to a paucity of data available from randomized clinical trials, leading to current guidelines relying more on non-randomized studies and expert opinions to make their recommendations. This review describes available evidence-based risk stratification methods for identifying patients at risk for SCD, as well as current guideline-driven management strategies for the use of ICDs in patients with CHD and inherited arrhythmia syndromes.

View Article and Find Full Text PDF

Purpose Of Review: The number of pregnancies complicated by valvular heart disease is increasing. This review describes the hemodynamic effects of clinically important valvular abnormalities during pregnancy and reviews current guideline-driven management strategies.

Recent Findings: Valvular heart disease in women of childbearing age is most commonly caused by congenital abnormalities and rheumatic heart disease.

View Article and Find Full Text PDF

Advancement in correction or palliation of congenital cardiac lesions has greatly improved the lifespan of congenital heart disease patients, resulting in a rapidly growing adult congenital heart disease (ACHD) population. As this group has increased in number and age, emerging science has highlighted the systemic nature of ACHD. Providers caring for these patients are tasked with long-term management of multiple neurologic, pulmonary, hepatic, renal, and endocrine manifestations that arise as syndromic associations with congenital heart defects or as sequelae of primary structural or hemodynamic abnormalities.

View Article and Find Full Text PDF

Background: This study was performed to test the hypothesis that there exists a correlation between the Butler-Leggett (BL) criterion for right ventricular hypertrophy on the electrocardiogram and the Qp/Qs shunt ratio in adults with ostium secundum atrial septal defects (ASDs).

Methods: Demographic, cardiac catheterization, ASD closure, and electrocardiographic data were acquired on 70 patients with secundum ASDs closed percutaneously. Simple linear regression and logistic regression models were created to test the hypothesis.

View Article and Find Full Text PDF

It is now well established that stromal interaction molecule 1 (STIM1) is the calcium sensor of endoplasmic reticulum stores required to activate store-operated calcium entry (SOC) channels at the surface of non-excitable cells. However, little is known about STIM1 in excitable cells, such as striated muscle, where the complement of calcium regulatory molecules is rather disparate from that of non-excitable cells. Here, we show that STIM1 is expressed in both myotubes and adult skeletal muscle.

View Article and Find Full Text PDF

Recent studies in chick and mouse embryos have identified a previously unrecognized secondary heart field (SHF), located in the ventral midline splanchnic mesenchyme, which provides additional myocardial cells to the outflow tract as the heart tube lengthens during cardiac looping. In order to further delineate the contribution of this secondary myocardium to outflow development, we labeled the right SHF of Hamburger-Hamilton (HH) stage 14 chick embryos via microinjection of DiI/rhodamine and followed the fluorescently labeled cells over a 96-h time period. These experiments confirmed the movement of the SHF into the outflow and its spiraling migration distally, with the right side of the SHF contributing to the left side of the outflow.

View Article and Find Full Text PDF

The arterial pole of the heart is the region where the ventricular myocardium continues as the vascular smooth muscle tunics of the aorta and pulmonary trunk. It has been shown that the arterial pole myocardium derives from the secondary heart field and the smooth muscle tunic of the aorta and pulmonary trunk derives from neural crest. However, this neural crest-derived smooth muscle does not extend to the arterial pole myocardium leaving a region at the base of the aorta and pulmonary trunk that is invested by vascular smooth muscle of unknown origin.

View Article and Find Full Text PDF