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Tutarel O, Baris L, Budts W, Gamal Abd-El Aziz M, Liptai C, Majdalany D, Jovanova S, Frogoudaki A, Connolly HM, Johnson MR, Maggioni AP, Hall R, Roos-Hesselink JW. Pregnancy outcomes in women with a systemic right ventricle and transposition of the great arteries results from the ESC-EORP Registry of Pregnancy and Cardiac disease (ROPAC). Heart 2021; 108:117-123. [PMID: 33911009 PMCID: PMC8717477 DOI: 10.1136/heartjnl-2020-318685] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2020] [Revised: 02/25/2021] [Accepted: 03/08/2021] [Indexed: 11/04/2022] Open
Abstract
Objective Cardiac disease is a major cause of maternal mortality. Data regarding pregnancy outcomes in women with a systemic right ventricle (sRV) are scarce. We studied pregnancy outcomes in women with an sRV after the atrial switch procedure for transposition of the great arteries (TGA) or congenitally corrected TGA (CCTGA). Methods The ESC EORP Registry of Pregnancy and Cardiac Disease is an international prospective registry of pregnant women with cardiac disease. Pregnancy outcomes (maternal/fetal) in all women with an sRV are described. The primary end point was a major adverse cardiac event (MACE) defined as maternal death, supraventricular or ventricular arrhythmias requiring treatment, heart failure, aortic dissection, endocarditis, ischaemic coronary event and other thromboembolic events. Results Altogether, 162 women with an sRV (TGA n=121, CCTGA n=41, mean age 28.8±4.6 years) were included. No maternal mortality occurred. In 26 women, at least one MACE occurred, heart failure in 16 (9.8%), arrhythmias (atrial 5, ventricular 6) in 11 (6.7%) and others in 4 (2.5%). Prepregnancy signs of heart failure as well as an sRV ejection fraction <40% were predictors of MACE. One woman experienced fetal loss, while no neonatal mortality was observed. No significant differences were found between women with CCTGA and TGA. In the subset of women who had an echocardiogram before and after pregnancy, no clear deterioration in sRV was observed. Conclusion The majority of women with an sRV tolerated pregnancy well with a favourable maternal and fetal outcome. Heart failure and arrhythmias were the most common MACE.
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Affiliation(s)
- Oktay Tutarel
- Department of Congenital Heart Disease and Paediatric Cardiology, German Heart Centre Munich, TUM School of Medicine, Technical University of Munich; DZHK (German Centre for Cardiovascular Research), partner site Munich Heart Alliance, Munich, Germany
| | - Lucia Baris
- Department of Cardiology, Erasmus Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Werner Budts
- Department of Cardiology, University Hospital Leuven, Leuven, Belgium
| | | | - Csilla Liptai
- Department of Cardiology, Semmelweis University Medical Center, Budapest, Hungary
| | - David Majdalany
- Department of Cardiology, Cleveland Clinic, Cleveland, Ohio, USA
| | - Silvana Jovanova
- Department of Cardiology, University Clinic of Cardiology, University t Cyril and Methodius, Skopje, North Macedonia
| | - Alexandra Frogoudaki
- Department of Cardiology, Adult Congenital Heart Clinic, Attikon University Hospital, Athens, Greece
| | - Heidi M Connolly
- Department of Cardiology, University of Rochester Medical Center, New York, New York, USA
| | - Mark R Johnson
- Department of Obstetric Medicine and Gynaecology, Imperial College London, Chelsea and Westminster Hospital, London, UK
| | - Aldo P Maggioni
- EURObservational Research Programme, European Society of Cardiology, France and Maria Cecilia Hospital, GVM Care & Research, Cotignola, Italy
| | - Roger Hall
- Department of Cardiology, University of East Anglia Norwich Medical School, Norwich, UK
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Niwa K. Adult Congenital Heart Disease with Pregnancy. Korean Circ J 2018; 48:251-276. [PMID: 29625509 PMCID: PMC5889976 DOI: 10.4070/kcj.2018.0070] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2018] [Accepted: 03/06/2018] [Indexed: 12/17/2022] Open
Abstract
The number of women with congenital heart disease (CHD) at risk of pregnancy is growing because over 90% of them are grown-up into adulthood. The outcome of pregnancy and delivery is favorable in most of them provided that functional class and systemic ventricular function are good. Women with CHD such as pulmonary hypertension (Eisenmenger syndrome), severe left ventricular outflow stenosis, cyanotic CHD, aortopathy, Fontan procedure and systemic right ventricle (complete transposition of the great arteries [TGA] after atrial switch, congenitally corrected TGA) carry a high-risk. Most frequent complications during pregnancy and delivery are heart failure, arrhythmias, bleeding or thrombosis, and rarely maternal death. Complications of fetus are prematurity, low birth weight, abortion, and stillbirth. Risk stratification of pregnancy and delivery relates to functional status of the patient and is lesion specific. Medication during pregnancy and post-delivery (breast feeding) is a big concern. Especially prescribing medication with teratogenicity should be avoidable. Adequate care during pregnancy, delivery, and the postpartum period requires a multidisciplinary team approach with cardiologists, obstetricians, anesthesiologists, neonatologists, nurses and other related disciplines. Caring for a baby is an important issue due to temporarily pregnancy-induced cardiac dysfunction, and therefore familial support is mandatory especially during peripartum and after delivery. Timely pre-pregnancy counseling should be offered to all women with CHD to prevent avoidable pregnancy-related risks. Successful pregnancy is feasible for most women with CHD at relatively low risk when appropriate counseling and optimal care are provided.
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Affiliation(s)
- Koichiro Niwa
- Department of Cardiology, Cardiovascular Center, St. Luke's International Hospital, Tokyo, Japan. ,
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3
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Vora MU, Christensen MJ, Markin NW. Perioperative Management of a Parturient After Atrial Switch Surgery for Dextro-Transposition of the Great Vessels. J Cardiothorac Vasc Anesth 2016; 31:669-674. [PMID: 27693205 DOI: 10.1053/j.jvca.2016.07.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2016] [Indexed: 11/11/2022]
Affiliation(s)
- Maulin U Vora
- University of Nebraska Medical Center, Omaha, Nebraska.
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4
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Cataldo S, Doohan M, Rice K, Trinder J, Stuart AG, Curtis SL. Pregnancy following Mustard or Senning correction of transposition of the great arteries: a retrospective study. BJOG 2015; 123:807-13. [DOI: 10.1111/1471-0528.13508] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/20/2015] [Indexed: 11/28/2022]
Affiliation(s)
- S Cataldo
- Adult Congenital Heart Disease Unit; Bristol Heart Institute; University Hospitals Bristol; Bristol UK
| | - M Doohan
- Department of Obstetrics; University Hospitals Bristol; Bristol UK
| | - K Rice
- Adult Congenital Heart Disease Unit; Bristol Heart Institute; University Hospitals Bristol; Bristol UK
| | - J Trinder
- Department of Obstetrics; University Hospitals Bristol; Bristol UK
| | - AG Stuart
- Adult Congenital Heart Disease Unit; Bristol Heart Institute; University Hospitals Bristol; Bristol UK
| | - SL Curtis
- Adult Congenital Heart Disease Unit; Bristol Heart Institute; University Hospitals Bristol; Bristol UK
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5
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Abstract
Cardiac disease in pregnancy is a challenging health care problem. The number of cases and their complexity is increasing, such that heart disease is now the leading cause of maternal mortality in developed countries. Numerically, women with congenital heart disease (CHD) make up the majority of cases and although maternal mortality is infrequent, a good outcome is only achieved though meticulous care, which starts pre-pregnancy and continues for months after the pregnancy has ended. All women with CHD should be assessed and counseled before pregnancy and carefully monitored during pregnancy, the delivery and in the puerperium. In most cases, pregnancy is well tolerated but in some conditions, such as pulmonary hypertension or severe dilatation of the aorta, pregnancy is extremely high risk and should be advised against.
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Affiliation(s)
- J W Roos-Hesselink
- Department of Cardiology, Erasmus Medical Center, Office Ba 583a, Postbus 2040, 3000 CA, Rotterdam, Netherlands.
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6
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Chugh R. Management of Pregnancy in Women With Repaired CHD or After the Fontan Procedure. CURRENT TREATMENT OPTIONS IN CARDIOVASCULAR MEDICINE 2013; 15:646-62. [DOI: 10.1007/s11936-013-0263-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Inoue S, Masuyama H, Akagi T, Hiramatsu Y. Pregnancy and delivery in patients with Fontan circulation: A report of two cases. J Obstet Gynaecol Res 2012; 39:378-82. [DOI: 10.1111/j.1447-0756.2012.01910.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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8
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Guía de práctica clínica de la ESC para el tratamiento de las enfermedades cardiovasculares durante el embarazo. Rev Esp Cardiol 2012. [DOI: 10.1016/j.recesp.2011.11.005] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
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9
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Guidelines for Indication and Management of Pregnancy and Delivery in Women with Heart Disease (JCS 2010): digest version. Circ J 2011; 76:240-60. [PMID: 22185717 DOI: 10.1253/circj.cj-88-0023] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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10
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Metz TD, Jackson GM, Yetman AT. Pregnancy outcomes in women who have undergone an atrial switch repair for congenital d-transposition of the great arteries. Am J Obstet Gynecol 2011; 205:273.e1-5. [PMID: 22071062 DOI: 10.1016/j.ajog.2011.06.042] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2011] [Revised: 04/29/2011] [Accepted: 06/09/2011] [Indexed: 11/27/2022]
Abstract
OBJECTIVE Women who underwent an atrial switch procedure (Senning or Mustard) for repair of d-transposition of the great arteries (d-TGA) are now of reproductive age. We sought to assess their ability for a successful pregnancy. STUDY DESIGN Clinical data were reviewed for all women of reproductive age who carried a diagnosis of d-TGA and atrial switch procedure who were observed at 2 tertiary care centers over 10 years. RESULTS Among 25 women who were identified, there were 21 pregnancies that resulted in 14 live births. The preterm birth rate was 50%. Pregnancy complications occurred in 5 women. There were no deaths. Serial echocardiographic data demonstrated a fall in right ventricular function during pregnancy, with some improvement postpartum. Intracardiac baffle obstruction that required postpartum stenting occurred in 36% of the completed pregnancies. CONCLUSION Women who have undergone an atrial switch procedure for d-TGA have high rates of pregnancy and cardiac complications and should be counseled accordingly.
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Affiliation(s)
- Torri D Metz
- Department of Obstetrics and Gynecology, University of Utah Health Sciences Center, Salt Lake City, UT, USA.
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11
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Regitz-Zagrosek V, Blomstrom Lundqvist C, Borghi C, Cifkova R, Ferreira R, Foidart JM, Gibbs JSR, Gohlke-Baerwolf C, Gorenek B, Iung B, Kirby M, Maas AHEM, Morais J, Nihoyannopoulos P, Pieper PG, Presbitero P, Roos-Hesselink JW, Schaufelberger M, Seeland U, Torracca L. ESC Guidelines on the management of cardiovascular diseases during pregnancy: the Task Force on the Management of Cardiovascular Diseases during Pregnancy of the European Society of Cardiology (ESC). Eur Heart J 2011; 32:3147-97. [PMID: 21873418 DOI: 10.1093/eurheartj/ehr218] [Citation(s) in RCA: 935] [Impact Index Per Article: 71.9] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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12
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Roche SL, Silversides CK, Oechslin EN. Monitoring the Patient with Transposition of the Great Arteries: Arterial Switch Versus Atrial Switch. Curr Cardiol Rep 2011; 13:336-46. [DOI: 10.1007/s11886-011-0185-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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13
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Sunman H, Canpolat U, Yorgun H, Gürgan T, Tokgözoglu L. Successful pregnancy by in vitro fertilization after Mustard operation for transposition of the great arteries. J Cardiol Cases 2011; 3:e50-e52. [PMID: 30532835 PMCID: PMC6265238 DOI: 10.1016/j.jccase.2010.08.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2010] [Revised: 08/18/2010] [Accepted: 08/30/2010] [Indexed: 11/15/2022] Open
Abstract
We report on a 32-year-old woman who had Mustard operation for transposition of great arteries and who underwent successful pregnancy by in vitro fertilization and without peripartum complications.
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Affiliation(s)
- Hamza Sunman
- Department of Cardiology, Hacettepe University, Ankara, Turkey
| | - Uğur Canpolat
- Department of Cardiology, Hacettepe University, Ankara, Turkey
| | - Hikmet Yorgun
- Department of Cardiology, Hacettepe University, Ankara, Turkey
| | - Timur Gürgan
- Department of Obstetrics and Gynecology, Hacettepe University, Ankara, Turkey
| | - Lale Tokgözoglu
- Department of Cardiology, Hacettepe University, Ankara, Turkey
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Silversides CK, Salehian O, Oechslin E, Schwerzmann M, Vonder Muhll I, Khairy P, Horlick E, Landzberg M, Meijboom F, Warnes C, Therrien J. Canadian Cardiovascular Society 2009 Consensus Conference on the management of adults with congenital heart disease: complex congenital cardiac lesions. Can J Cardiol 2010; 26:e98-117. [PMID: 20352139 DOI: 10.1016/s0828-282x(10)70356-1] [Citation(s) in RCA: 66] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
With advances in pediatric cardiology and cardiac surgery, the population of adults with congenital heart disease (CHD) has increased. In the current era, there are more adults with CHD than children. This population has many unique issues and needs. They have distinctive forms of heart failure and their cardiac disease can be associated with pulmonary hypertension, thromboemboli, complex arrhythmias and sudden death. Medical aspects that need to be considered relate to the long-term and multisystemic effects of single ventricle physiology, cyanosis, systemic right ventricles, complex intracardiac baffles and failing subpulmonary right ventricles. Since the 2001 Canadian Cardiovascular Society Consensus Conference report on the management of adults with CHD, there have been significant advances in the field of adult CHD. Therefore, new clinical guidelines have been written by Canadian adult CHD physicians in collaboration with an international panel of experts in the field. Part III of the guidelines includes recommendations for the care of patients with complete transposition of the great arteries, congenitally corrected transposition of the great arteries, Fontan operations and single ventricles, Eisenmenger's syndrome, and cyanotic heart disease. Topics addressed include genetics, clinical outcomes, recommended diagnostic workup, surgical and interventional options, treatment of arrhythmias, assessment of pregnancy risk and follow-up requirements. The complete document consists of four manuscripts, which are published online in the present issue of The Canadian Journal of Cardiology. The complete document and references can also be found at www.ccs.ca or www.cachnet.org.
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15
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Manso B, Gran F, Pijuán A, Giralt G, Ferrer Q, Betrián P, Albert D, Rosés F, Rivas N, Parra M, Girona J, Farrán I, Casaldáliga J. Embarazo y cardiopatías congénitas. Rev Esp Cardiol 2008. [DOI: 10.1157/13116650] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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16
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Chugh R. Management of pregnancy in women with palliated and unpalliated congenital heart defects. CURRENT TREATMENT OPTIONS IN CARDIOVASCULAR MEDICINE 2007; 9:414-27. [PMID: 17897571 DOI: 10.1007/s11936-007-0062-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Medical advancements have made it possible for more women with congenital heart defects (CHDs) to carry successful pregnancies. Most CHD surgeries or interventions are palliative with persistent residua and sequelae exacerbated by the physiologic stresses of pregnancy. Preconception assessment, a tailored multidisciplinary approach during pregnancy, and a planned, elective delivery followed by careful postpartum monitoring may improve outcomes. Teratogenic medications should be stopped and changed to safer alternatives. Major hemodynamic changes in pregnancy, labor, and delivery may aggravate the underlying cardiovascular defects. Interventions or surgeries, when anticipated, should be performed before pregnancy. Antibiotic prophylaxis is indicated for nearly all palliated and unpalliated defects.
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Affiliation(s)
- Reema Chugh
- Adult Congenital Heart Disease and Heart Disease in Pregnancy, Kaiser Foundation Hospitals, Department of Cardiology, 13652 Cantara Street, Area 308, Panorama City, CA 91402, USA.
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17
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Drenthen W, Pieper PG, Roos-Hesselink JW, van Lottum WA, Voors AA, Mulder BJM, van Dijk APJ, Vliegen HW, Yap SC, Moons P, Ebels T, van Veldhuisen DJ. Outcome of pregnancy in women with congenital heart disease: a literature review. J Am Coll Cardiol 2007; 49:2303-11. [PMID: 17572244 DOI: 10.1016/j.jacc.2007.03.027] [Citation(s) in RCA: 349] [Impact Index Per Article: 20.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2006] [Revised: 02/27/2007] [Accepted: 03/13/2007] [Indexed: 01/18/2023]
Abstract
A search of peer-reviewed literature was conducted to identify reports that provide data on complications associated with pregnancy in women with structural congenital heart disease (CHD). This review describes the outcome of 2,491 pregnancies, including 377 miscarriages (15%) and 114 elective abortions (5%). Important cardiac complications were seen in 11% of the pregnancies. Obstetric complications do not appear to be more prevalent. In complex CHD, premature delivery rates are high, and more children are small for gestational age. The offspring mortality was high throughout the spectrum and was related to the relatively high rate of premature delivery and recurrence of CHD.
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Affiliation(s)
- Willem Drenthen
- Department of Cardiology, University Medical Center Groningen, Groningen, The Netherlands.
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18
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Khairy P, Ouyang DW, Fernandes SM, Lee-Parritz A, Economy KE, Landzberg MJ. Pregnancy Outcomes in Women With Congenital Heart Disease. Circulation 2006; 113:517-24. [PMID: 16449731 DOI: 10.1161/circulationaha.105.589655] [Citation(s) in RCA: 291] [Impact Index Per Article: 16.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background—
Pregnant women with congenital heart disease are at increased risk for cardiac and neonatal complications, yet risk factors for adverse outcomes are not fully defined.
Methods and Results—
Between January 1998 and September 2004, 90 pregnancies at age 27.7±6.1 years were followed in 53 women with congenital heart disease. Spontaneous abortions occurred in 11 pregnancies at 10.8±3.7 weeks, and 7 underwent elective pregnancy termination. There were no maternal deaths. Primary maternal cardiac events complicated 19.4% of ongoing pregnancies, with pulmonary edema in 16.7% and sustained arrhythmias in 2.8%. Univariate risk factors included prior history of heart failure (odds ratio [OR], 15.5), NYHA functional class ≥2 (OR, 5.4), and decreased subpulmonary ventricular ejection fraction (OR, 7.7). Independent predictors were decreased subpulmonary ventricular ejection fraction and/or severe pulmonary regurgitation (OR, 9.0) and smoking history (OR, 27.2). Adverse neonatal outcomes occurred in 27.8% of ongoing pregnancies and included preterm delivery (20.8%), small for gestational age (8.3%), respiratory distress syndrome (8.3%), intraventricular hemorrhage (1.4%), intrauterine fetal demise (2.8%), and neonatal death (1.4%). A subaortic ventricular outflow tract gradient >30 mm Hg independently predicted an adverse neonatal outcome (OR, 7.5). Cardiac risk assessment was improved by including decreased subpulmonary ventricular systolic function and/or severe pulmonary regurgitation (OR, 10.3) in a previously proposed risk index developed in pregnant women with acquired and congenital heart disease.
Conclusions—
Maternal cardiac and neonatal complication rates are considerable in pregnant women with congenital heart disease. Patients with impaired subpulmonary ventricular systolic function and/or severe pulmonary regurgitation are at increased risk for adverse cardiac outcomes.
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Affiliation(s)
- Paul Khairy
- Boston Adult Congenital Heart Service, Brigham and Women's Hospital, Boston, MA, USA.
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19
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Abstract
Congenital heart disease is now more prevalent than acquired in pregnancy in the developed world. In pregnancy the fall in systemic vascular resistance and increase in blood volume and cardiac output can cause functional deterioration in certain conditions. A minimally symptomatic woman with good ventricular function, normal oxygen saturation, and no left heart obstruction should tolerate pregnancy well. Women with pulmonary hypertension or dilated aortic root (pre-replacement) should be counselled against pregnancy and given appropriate contraceptive advice. The optimum management of a pregnant woman with a metallic prosthetic valve remains to be determined.
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Affiliation(s)
- C E G Head
- Department of Cardiology, University Hospital, Birmingham, UK.
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20
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Drenthen W, Pieper PG, Ploeg M, Voors AA, Roos-Hesselink JW, Mulder BJM, Vliegen HW, Sollie KM, Ebels T, van Veldhuisen DJ. Risk of complications during pregnancy after Senning or Mustard (atrial) repair of complete transposition of the great arteries. Eur Heart J 2005; 26:2588-95. [PMID: 16126718 DOI: 10.1093/eurheartj/ehi472] [Citation(s) in RCA: 100] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
AIMS To investigate magnitude and determinants of risks during pregnancy in women with Mustard or Senning repair for complete transposition of the great arteries (TGA). METHODS AND RESULTS Using a nationwide registry (CONCOR), 70 women with Senning (23%) or Mustard (77%) repair for TGA were enrolled. A total of 28 patients had 69 pregnancies (two twins), including 17 spontaneous miscarriages and three elective abortions. During 39 of the 49 completed pregnancies, complications were observed. The most important cardiac complication was clinically significant arrhythmia (n=11, 22%), especially occurring in patients with a prior history of arrhythmia. Important general pregnancy complications were preeclampsia (n=5, 10.2%) and pregnancy-induced hypertension (n=4, 8.2%). Obstetric complications included premature rupture of membranes (n=7, 14.3%), premature labour (n=12, 24.4%), premature delivery (n=16, 31.4%), and thrombo-embolic complications (n=2, 4.1%). Mean (singleton) pregnancy duration was 36+/-5 weeks. Eleven of the 51 children (21.6%) were small for gestational age. Foetal and neonatal mortality combined was 11.8% (n=6). No recurrence of congenital heart disease in the offspring was documented. CONCLUSION In this largest report on pregnancy in women with atrial-corrected TGA to date, a high incidence of obstetric complications and mortality in the offspring was observed.
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Affiliation(s)
- Willem Drenthen
- Department of Cardiology, University Medical Center Groningen, PO Box 30.001, 9700 RB Groningen, The Netherlands
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Abbas AE, Lester SJ, Connolly H. Pregnancy and the cardiovascular system. Int J Cardiol 2005; 98:179-89. [PMID: 15686766 DOI: 10.1016/j.ijcard.2003.10.028] [Citation(s) in RCA: 96] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2003] [Revised: 08/13/2003] [Accepted: 10/14/2003] [Indexed: 10/26/2022]
Abstract
The cardiovascular system undergoes important adaptations during pregnancy to accommodate for fetal requirements. This causes a hemodynamic burden on patients with underlying heart disease, and is associated with significant morbidity and mortality. Moreover, certain cardiovascular diseases may be due to pregnancy. Although unusual, these diseases can pose a threat to the pregnant woman and her fetus. This review will discuss cardiovascular adaptations to pregnancy as well as the risk of pregnancy in patients with underlying heart disease. It will also provide a brief overview of cardiovascular disorders associated with pregnancy.
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Affiliation(s)
- Amr E Abbas
- Division of Cardiovascular Diseases, Mayo Clinic, Scottsdale, AZ 85259, USA.
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Tateno S, Niwa K, Nakazawa M, Akagi T, Shinohara T, Yasuda T. Arrhythmia and conduction disturbances in patients with congenital heart disease during pregnancy: multicenter study. Circ J 2004; 67:992-7. [PMID: 14639012 DOI: 10.1253/circj.67.992] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
The incidence, manifestation and management of arrhythmia in congenital heart disease (CHD) during pregnancy were evaluated in a multicenter study. Of 126 pregnancies in patients with CHD in 17 institutions from January 1991 to December 2000, 29 cases of pregnancy in 27 patients after cardiac repair (mean age, 29+/-4.9 years) were identified with arrhythmias (supraventricular tachyarrhythmia (SVT) in 15, ventricular tachycardia (VT) in 9, high-grade atrioventricular block in 4 and sick sinus syndrome in 3) (group A) and 29 control pregnancies from 29 patients with repaired CHD and no arrhythmias (group B). SVT tended to require anti-arrhythmic medication more than VT (10/15 vs 2/9, p=0.04). Nine different types of anti-arrhythmic agents were successfully administered without maternal complications. There were no maternal deaths in either group. In the comparison of group A with group B, there was lower cardiac functional class (8/29, p=0.04), higher incidence of polysplenia (4/29, p=0.04), and higher incidence of low-birthweight infant (7/29, p=0.02) in the former. It appears that there is a high prevalence of arrhythmias during pregnancy in patients with repaired CHD. Patients with CHD and low cardiac functional class and/or polysplenia could have arrhythmia during pregnancy that results in a low-birthweight infant. Meticulous care for these patients during pregnancy is recommended.
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Affiliation(s)
- Shigeru Tateno
- Department of Pediatrics, Chiba Cardiovascular Center, Chiba, Japan
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Guédès A, Mercier LA, Leduc L, Bérubé L, Marcotte F, Dore A. Impact of pregnancy on the systemic right ventricle after a Mustard operation for transposition of the great arteries. J Am Coll Cardiol 2004; 44:433-7. [PMID: 15261944 DOI: 10.1016/j.jacc.2004.04.037] [Citation(s) in RCA: 135] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2004] [Revised: 03/22/2004] [Accepted: 04/06/2004] [Indexed: 11/16/2022]
Abstract
OBJECTIVES We sought to determine the impact of pregnancy on the systemic right ventricle (RV) after a Mustard operation for transposition of the great arteries. BACKGROUND Dysfunction of the RV remains a continuing problem after a Mustard operation. Concerns exist about the potentially deleterious effects of pregnancy on this ventricle. METHODS The records of 16 women who completed 28 pregnancies were reviewed for clinical status, echocardiographic evaluation of RV dimensions, RV function, and tricuspid regurgitation (TR) before, during, and after pregnancy. RESULTS Women were in New York Heart Association functional class I (n = 21) and II (n = 7) before pregnancy. The functional class deteriorated in six women, with no return to the pre-pregnancy level after delivery in two. Data on RV dimensions were available in 18 pregnancies, on RV function in 21, and on TR in 20. Before pregnancy, RV dilation was absent (n = 4), mild/moderate (n = 12), or severe (n = 2) and progressed in five women (31%), with no recovery in all patients at the last follow-up. Right ventricular systolic dysfunction was absent (n = 16), mild/moderate (n = 4), or severe (n = 1) before pregnancy and progressed in four women (25%), with no recovery in three cases. Tricuspid regurgitation was absent (n = 8), mild (n = 9), or moderate (n = 3) before pregnancy and deteriorated in eight women (50%), with no recovery in three patients. CONCLUSIONS Pregnancy after a Mustard operation is clinically well tolerated but carries a risk of RV dysfunction, which is sometimes irreversible.
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Affiliation(s)
- Antoine Guédès
- Department of Medicine, Montreal Heart Institute, Montreal, Quebec, Canada
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Koos BJ. Management of uncorrected, palliated, and repaired cyanotic congenital heart disease in pregnancy. PROGRESS IN PEDIATRIC CARDIOLOGY 2004. [DOI: 10.1016/j.ppedcard.2003.09.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
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Nieminen H, Sairanen H, Tikanoja T, Leskinen M, Ekblad H, Galambosi P, Jokinen E. Long-term results of pediatric cardiac surgery in Finland: education, employment, marital status, and parenthood. Pediatrics 2003; 112:1345-50. [PMID: 14654608 DOI: 10.1542/peds.112.6.1345] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
OBJECTIVE This population-based study was designed to examine the psychosocial outcome of Finnish patients who had been operated on for congenital heart disease during childhood. METHODS A questionnaire was mailed to 3789 adult patients who had been operated on for congenital heart defects in Finland. Of these, 2896 (76%) answered the questionnaire. The mean age of patients was 33 years (range: 18-59 years), and they had had their first operation 9 to 46 years earlier. RESULTS The patients had coped well with their defects when compared with the general Finnish population. The educational level of patients was comparable to and employment level was higher than expected (70% vs 66%, respectively). They were living in a steady relationship as often as the general population, but the number of parents among the patients was lower than that expected (47% vs 49%, respectively). The incidence of congenital heart disease among the 2697 children of the patients was 2.4%. CONCLUSION Our results confirm that in addition to high survival rate, the long-term psychosocial outcome of patients with surgically treated congenital heart defects is good if they do not have any additional syndromes that cause mental retardation.
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Affiliation(s)
- Heta Nieminen
- Department of Pediatrics, Hospital for Children and Adolescents, University of Helsinki, Helsinki, Finland
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Siu SC, Colman JM, Sorensen S, Smallhorn JF, Farine D, Amankwah KS, Spears JC, Sermer M. Adverse neonatal and cardiac outcomes are more common in pregnant women with cardiac disease. Circulation 2002; 105:2179-84. [PMID: 11994252 DOI: 10.1161/01.cir.0000015699.48605.08] [Citation(s) in RCA: 249] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Pregnant women with heart disease (HD) are at increased risk for cardiac (CV) complications. However, the frequency of neonatal (NE) complications in pregnant women with HD relative to pregnant women without HD has not been examined. METHODS AND RESULTS Pregnant women with HD were prospectively monitored during 302 pregnancies. The frequency of NE and CV complications was compared with those in a control group without HD during 572 pregnancies. The frequency of NE complications was higher in the HD group (18% versus 7%; HD versus controls). The NE complication rate was lowest in pregnancies of women age 20 to 35 years who did not smoke during pregnancy, did not receive anticoagulants, and had no obstetric risk factors: 4% in control patients, 5% in HD patients with no cardiac risk factors for NE complications (left heart obstruction, poor functional class, or cyanosis), and 7% in HD patients with > or =1 such risk factor. In contrast, the event rate in pregnancies of controls age <20 or >35 years who had obstetric risk factors or multiple gestation or who smoked was 11%. In the HD group, women age <20 or >35 years who had obstetric risk factors or multiple gestation, who smoked, or who received anticoagulants experienced an even higher NE complication rate (27% with no cardiac risks for NE events and 33% in the presence of >or =1 cardiac risk factors). The frequency of CV complications was higher in the HD group (17% versus 0%; HD versus controls). CONCLUSION Pregnant women with HD are at increased risk for both NE and CV complications. The risk for NE adverse events in pregnant women with HD is highest in those with both obstetric and cardiac risk factors for NE complications.
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Affiliation(s)
- Samuel C Siu
- Department of Medicine, Division of Cardiology, University of Toronto, Toronto, Ontario, Canada.
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Siu SC, Sermer M, Colman JM, Alvarez AN, Mercier LA, Morton BC, Kells CM, Bergin ML, Kiess MC, Marcotte F, Taylor DA, Gordon EP, Spears JC, Tam JW, Amankwah KS, Smallhorn JF, Farine D, Sorensen S. Prospective multicenter study of pregnancy outcomes in women with heart disease. Circulation 2001; 104:515-21. [PMID: 11479246 DOI: 10.1161/hc3001.093437] [Citation(s) in RCA: 756] [Impact Index Per Article: 32.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
BACKGROUND The maternal and neonatal risks associated with pregnancy in women with heart disease receiving comprehensive prenatal care have not been well defined. METHODS AND RESULTS We prospectively enrolled 562 consecutive pregnant women with heart disease and determined the outcomes of 599 pregnancies not ending in miscarriage. Pulmonary edema, arrhythmia, stroke, or cardiac death complicated 13% of pregnancies. Prior cardiac events or arrhythmia, poor functional class or cyanosis, left heart obstruction, and left ventricular systolic dysfunction independently predicted maternal cardiac complications; the cardiac event rate can be predicted using a risk index incorporating these predictors. Neonatal complications (20% of pregnancies) were associated with poor functional class or cyanosis, left heart obstruction, anticoagulation, smoking, and multiple gestations. CONCLUSIONS Pregnancy in women with heart disease is associated with significant cardiac and neonatal complications, despite state-of-the-art obstetric and cardiac care. Maternal cardiac risk can be predicted with the use of a risk index.
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Affiliation(s)
- S C Siu
- University of Toronto, Toronto, Ontario, Canada.
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Affiliation(s)
- S C Siu
- University of Toronto Congenital Cardiac Centre for Adults, University Health Network and Mount Sinai Hospital, Toronto, Ontario, Canada.
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ISERIN LAURENCE. Management of pregnancy in women with congenital heart disease. BRITISH HEART JOURNAL 2001. [DOI: 10.1136/hrt.85.5.493] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Foster E, Graham TP, Driscoll DJ, Reid GJ, Reiss JG, Russell IA, Sermer M, Siu SC, Uzark K, Williams RG, Webb GD. Task force 2: special health care needs of adults with congenital heart disease. J Am Coll Cardiol 2001; 37:1176-83. [PMID: 11300419 DOI: 10.1016/s0735-1097(01)01277-3] [Citation(s) in RCA: 146] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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