Migraine and coarctation of the aorta: prevalence and risk factors.

OBJECTIVES: We previously described a potential relationship between the presence of migraine and congenital heart defects. It has been hypothesized that a genetic substrate might determine for congenital heart defects and migraine. Therefore, we wanted to study the prevalence of migraine in female patients with coarctation of the aorta (CA) and to determine predictive variables for migraine in this specific population. METHODS: All patients with CA, previously selected for the ZAHARA trial to evaluate pregnancies and outcome, were recruited from the database of congenital heart disease of the University Hospital of Leuven. These patients were contacted by phone and asked to complete a structured headache questionnaire. Based on this questionnaire, a neurologist blinded to the patients' files, diagnosed migraine without or with aura (MA- and MA+, respectively), according to the international headache criteria. Demographic, clinical, and technical data were obtained by reviewing the patients' records. RESULTS: Thirty-four female patients (age 32.2 +/- 6.3 y) were included in the study. The overall prevalence of migraine in female CA patients was 38%, of which 12% were MA- and 26% MA+. No significant relationship between demographic, clinical, and technical variables and migraine could be determined, except for migraine and the number of pregnancies and smoking behaviour (univariate logistic regression; B = 1.2 and 1.9, P = 0.039 and 0.027, respectively). CONCLUSION: In this study, we found a relatively high prevalence of migraine in female adult CA patients. We could also demonstrate a positive relationship between migraine, smoking behaviour, and the number of pregnancies. Therefore, we should pay more attention to these findings in daily practice.

Innervation of the atrioventricular and semi-lunar heart valves: a review.

Heart valves were historically considered passive structures that function through the haemodynamic forces created by the contraction and relaxation of the myocardium. However, research into valvular structures has revealed that heart valves are very complex, specialized structures that contain both smooth muscle cells and nerve fibres. This is particularly true for the atrioventricular valves, which are by far the most well studied to date. The various heart valves have been shown to contract independently during different moments of the heart cycle, suggesting that compensatory adaptation mechanisms exist to mediate the timing and efficacy of heart valve closure. These adaptations occur via different mechanisms, including neural mechanisms that influence the heart valves. Accumulating evidence continues to improve our understanding of the nerve fibres in the heart (adrenergic, cholinergic, etc.). Future studies will no doubt add to this exciting picture. Here, we review the current morphological knowledge of human and animal heart valve innervation, including discussions of the chordae tendineae and the papillary muscles, as well as the differences between the atrioventricular (AV) valves and the semi-lunar (SL) valves.