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Ghazaryan N, Adamyan M, Khachatryan L, Hovakimyan T. Syncope in a pregnant woman with repaired Tetralogy of Fallot: a case report. Eur Heart J Case Rep 2022; 6:ytac209. [PMID: 35668843 PMCID: PMC9161714 DOI: 10.1093/ehjcr/ytac209] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Revised: 01/05/2022] [Accepted: 05/17/2022] [Indexed: 11/26/2022]
Abstract
Background Tetralogy of Fallot (TOF) is one of the most widespread cyanotic congenital heart disease (CHD), which can be successfully repaired in the neonatal period. However, residual problems and the surgical technique itself can create a favourable basis for arrhythmias and conduction abnormalities in these patients. Sometimes, these arrhythmias may worsen during pregnancy and require urgent intervention. Case summary This is a case of a 25-year-old woman, who underwent a surgical repair of TOF at the age of 2 years. She suffered an ischaemic stroke postoperatively, which was complicated with secondary seizures and syncope. These episodes were evaluated as epilepsy. The patient was admitted to our hospital with the above-mentioned complaints in the 10th week of pregnancy. A comprehensive cardiac examination was performed. Her presyncopal event was captured during Holter monitoring, which documented a severe dysfunction of the sinus node. She was diagnosed with postoperative sick sinus syndrome and implanted with a permanent dual-chamber pacemaker (PM). After the operation, the patient did not have any episodes of syncope or seizures and the PM check-up showed almost 30% of atrial pacing. Conclusion No matter how obvious the neurological or other nature of syncope may seem, it is advised to exclude the cardiac origin of syncope, especially in patients with repaired CHD. One of the most common complications after surgery of CHD is rhythm and conduction disturbances. In some of these cases, permanent PM implantation can be unavoidable, even during pregnancy. The implantation of the PM device during pregnancy can be performed safely.
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Affiliation(s)
- Nare Ghazaryan
- Nork-Marash Medical Center , Armenak Armenakyan St. 13, 0047 Yerevan, Armenia
| | - Miqayel Adamyan
- Nork-Marash Medical Center , Armenak Armenakyan St. 13, 0047 Yerevan, Armenia
| | - Lianna Khachatryan
- Nork-Marash Medical Center , Armenak Armenakyan St. 13, 0047 Yerevan, Armenia
| | - Tatevik Hovakimyan
- Nork-Marash Medical Center , Armenak Armenakyan St. 13, 0047 Yerevan, Armenia
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Kampman MAM, Siegmund AS, Bilardo CM, van Veldhuisen DJ, Balci A, Oudijk MA, Groen H, Mulder BJM, Roos-Hesselink JW, Sieswerda G, de Laat MWM, Sollie-Szarynska KM, Pieper PG. Uteroplacental Doppler flow and pregnancy outcome in women with tetralogy of Fallot. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2017; 49:231-239. [PMID: 27071979 DOI: 10.1002/uog.15938] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/06/2016] [Revised: 04/01/2016] [Accepted: 04/07/2016] [Indexed: 06/05/2023]
Abstract
OBJECTIVE Pregnancy in women with surgically corrected tetralogy of Fallot (ToF) is associated with cardiac, obstetric and neonatal complications. We compared uteroplacental Doppler flow (UDF) measurements and pregnancy outcome in women with ToF and in healthy women and aimed to assess whether a relationship exists between cardiac function and UDF in women with ToF. METHODS We evaluated prospectively pregnant women with ToF and healthy pregnant women from the ZAHARA studies. Clinical evaluation, standardized echocardiography and UDF measurements were performed at 20 and 32 weeks' gestation. RESULTS We included 62 women with ToF and 69 healthy controls. Cardiac complications, mostly arrhythmia, occurred in 8.1% of women with ToF. There was a higher incidence of small-for-gestational age (21.0% vs 4.4%, P = 0.004) and low birth weight (16.1% vs 2.9%, P = 0.009) in the group of women with ToF than in healthy controls. In women with ToF, early diastolic notching of uterine artery waveform at 20 and 32 weeks occurred more frequently (9.8% vs 1.5%, P = 0.034 and 7.0% vs 0%, P = 0.025, respectively) and the umbilical artery pulsatility index at 32 weeks was higher (1.02 ± 0.20 vs 0.94 ± 0.17, P = 0.015) than in healthy controls. Right ventricular function parameters prepregnancy and at 20 weeks' gestation were significantly associated with abnormal UDF. UDF parameters were associated with adverse neonatal outcome. CONCLUSION The majority of women with surgically corrected ToF tolerate pregnancy well. However, UDF indices are more frequently abnormal in these women, suggesting impaired placentation. The association of impaired right ventricular function parameters with abnormal UDF suggests that cardiac dysfunction contributes to defective placentation or placental perfusion mismatch and may explain the increased incidence of obstetric and neonatal complications. Copyright © 2016 ISUOG. Published by John Wiley & Sons Ltd.
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Affiliation(s)
- M A M Kampman
- Department of Cardiology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
- The Netherlands Heart Institute (ICIN), Utrecht, The Netherlands
| | - A S Siegmund
- Department of Cardiology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - C M Bilardo
- Department of Obstetrics, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - D J van Veldhuisen
- Department of Cardiology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - A Balci
- Department of Cardiology, Isala, Zwolle, The Netherlands
| | - M A Oudijk
- Department of Obstetrics, University Medical Center Utrecht, University of Utrecht, Utrecht, The Netherlands
| | - H Groen
- Department of Epidemiology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - B J M Mulder
- Department of Cardiology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - J W Roos-Hesselink
- Department of Cardiology, Erasmus Medical Center, University of Rotterdam, Rotterdam, The Netherlands
| | - G Sieswerda
- Department of Cardiology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - M W M de Laat
- Department of Obstetrics, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - K M Sollie-Szarynska
- Department of Obstetrics, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - P G Pieper
- Department of Cardiology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
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3
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Gelson E, Curry R, Gatzoulis MA, Swan L, Lupton M, Steer PJ, Johnson MR. Maternal cardiac and obstetric performance in consecutive pregnancies in women with heart disease. BJOG 2015; 122:1552-9. [DOI: 10.1111/1471-0528.13489] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/02/2015] [Indexed: 11/28/2022]
Affiliation(s)
- E Gelson
- Academic Department of Obstetrics and Gynaecology; Imperial College London; Chelsea and Westminster Hospital; London UK
| | - R Curry
- Academic Department of Obstetrics and Gynaecology; Imperial College London; Chelsea and Westminster Hospital; London UK
- Department of Maternal and Fetal Medicine; Institute for Women's Health; University College London; London UK
| | - MA Gatzoulis
- Adult Congenital Heart Centre; The National Heart and Lung Institute; Imperial College London; Royal Brompton Hospital; London UK
| | - L Swan
- Adult Congenital Heart Centre; The National Heart and Lung Institute; Imperial College London; Royal Brompton Hospital; London UK
| | - M Lupton
- Academic Department of Obstetrics and Gynaecology; Imperial College London; Chelsea and Westminster Hospital; London UK
- Adult Congenital Heart Centre; The National Heart and Lung Institute; Imperial College London; Royal Brompton Hospital; London UK
| | - PJ Steer
- Academic Department of Obstetrics and Gynaecology; Imperial College London; Chelsea and Westminster Hospital; London UK
| | - MR Johnson
- Academic Department of Obstetrics and Gynaecology; Imperial College London; Chelsea and Westminster Hospital; London UK
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Kamiya CA, Iwamiya T, Neki R, Katsuragi S, Kawasaki K, Miyoshi T, Sasaki Y, Osato K, Murohara T, Ikeda T. Outcome of Pregnancy and Effects on the Right Heart in Women With Repaired Tetralogy of Fallot. Circ J 2012; 76:957-63. [DOI: 10.1253/circj.cj-11-1239] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Affiliation(s)
- Chizuko A. Kamiya
- Departments of Perinatology and Gynecology, National Cerebral and Cardiovascular Center
- Department of Cardiology, Nagoya University Graduate School of Medicine
| | - Tadashi Iwamiya
- Gynecological Department, Osaka Medical Center for Cancer and Cardiovascular Diseases
| | - Reiko Neki
- Departments of Perinatology and Gynecology, National Cerebral and Cardiovascular Center
| | - Shinji Katsuragi
- Departments of Perinatology and Gynecology, National Cerebral and Cardiovascular Center
| | - Kaoru Kawasaki
- Departments of Perinatology and Gynecology, National Cerebral and Cardiovascular Center
| | - Takakazu Miyoshi
- Departments of Perinatology and Gynecology, National Cerebral and Cardiovascular Center
| | - Yoshihito Sasaki
- Departments of Perinatology and Gynecology, National Cerebral and Cardiovascular Center
| | - Kazuhiro Osato
- Departments of Perinatology and Gynecology, National Cerebral and Cardiovascular Center
| | - Toyoaki Murohara
- Department of Cardiology, Nagoya University Graduate School of Medicine
| | - Tomoaki Ikeda
- Department of Obstetrics and Gynecology, Mie University Graduate School of Medicine
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Al-Aqeedi RF, Alnabti A, Al-Ani F, Dabdoob W, Abdullatef WK. Successful delivery by a cesarean section in a parturient with severe dilated cardiomyopathy, an implantable cardioverter defibrillator, and a repaired tetralogy of fallot. Heart Views 2011; 12:26-31. [PMID: 21731806 PMCID: PMC3123513 DOI: 10.4103/1995-705x.81556] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Repaired congenital heart disease has become more prevalent in women of childbearing age. We report an unusual case of a 24-year-old multigravida with a repaired tetralogy of Fallot, severe dilated cardiomyopathy, and implantable cardioverter defibrillator placement who was managed successfully by a cesarean section three times. This case underscores the impact of such events on maternal and fetal safety and the importance of a multidisciplinary approach in the management of pregnant patients with complex congenital and medical problems.
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Affiliation(s)
- Rafid Fayadh Al-Aqeedi
- Department of Cardiology and Cardiovascular Surgery, Hamad Medical Corporation, Doha, Qatar
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6
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Obstetric outcomes in pregnant women with congenital heart disease. Int J Cardiol 2010; 144:195-9. [DOI: 10.1016/j.ijcard.2009.04.006] [Citation(s) in RCA: 60] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2008] [Revised: 03/21/2009] [Accepted: 04/04/2009] [Indexed: 11/19/2022]
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Wu ET, Akagi T, Taniguchi M, Maruo T, Sakuragi S, Otsuki S, Okamoto Y, Sano S. Differences in right and left ventricular remodeling after transcatheter closure of atrial septal defect among adults. Catheter Cardiovasc Interv 2007; 69:866-71. [PMID: 17390329 DOI: 10.1002/ccd.21075] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
OBJECTIVES To evaluate acute cardiac remodeling after transcatheter closure of atrial septal defect (ASD) in adult patients. BACKGROUND In adult patients with ASD, longer periods of cardiac adaptation should be expected after the procedure due to long-standing RV volume overload and subsequent changes in the pulmonary vasculature. There are limited reports about this remodeling in adult patients. METHODS We prospectively enrolled 17 adults (mean age 58.4 +/- 17.3 years) who underwent successful transcatheter closure of their ASDs from August 2005 to July 2006. We performed routine transthoracic echocardiographic studies, including LV and RV myocardial performance indices, or Tei indices, and plasma brain natriuretic peptide (BNP) sampling before closure of the ASD, and 1 day, 1 month, and 3 months after closure. RESULTS We found (1) LV end diastolic diameter increased, and RVEDD decreased markedly after the closure; (2) differences existed in LV and RV adaptation. While LV Tei index improved soon after the procedure, RV Tei index worsened until 1 month after the procedure, then recovered by the 3 month follow-up visit; and (3) BNP elevated 1 day after closure of the ASD and declined by the 1-month follow-up visit. CONCLUSION "Shrinkage" of the RV and "expansion" of the LV occurred soon after the procedure, even in elderly patients. Device closure of ASDs caused rapid improvement of LV function, but RV function underwent transient deterioration, probably due to delayed changes in RV ventricular mass in the face of acute volume reduction in this aged cohort.
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MESH Headings
- Adult
- Aged
- Aged, 80 and over
- Cardiac Catheterization
- Echocardiography
- Echocardiography, Doppler, Color
- Female
- Follow-Up Studies
- Heart Septal Defects, Atrial/blood
- Heart Septal Defects, Atrial/diagnostic imaging
- Heart Septal Defects, Atrial/physiopathology
- Heart Septal Defects, Atrial/therapy
- Heart Ventricles/diagnostic imaging
- Humans
- Male
- Middle Aged
- Natriuretic Peptide, Brain/blood
- Prospective Studies
- Reproducibility of Results
- Time Factors
- Treatment Outcome
- Ventricular Function, Left
- Ventricular Function, Right
- Ventricular Remodeling
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Affiliation(s)
- En-Ting Wu
- Cardiac Care Unit, Okayama University Hospital, Okayama, Japan
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Kuwahara E, Otsuji Y, Takasaki K, Yuasa T, Kumanohoso T, Nakashima H, Toyonaga K, Yoshifuku S, Miyata M, Hamasaki S, Lee S, Kisanuki A, Minagoe S, Tei C. Increased Tei index suggests absence of adequate coronary reperfusion in patients with first anteroseptal acute myocardial infarction. Circ J 2006; 70:248-53. [PMID: 16501288 DOI: 10.1253/circj.70.248] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND The estimation of coronary reperfusion in acute myocardial infarction (AMI) is important. The left ventricular (LV) Tei index is a noninvasive and sensitive parameter expressing overall LV function. We hypothesized that patients without good coronary reperfusion have worse LV function with a higher or worse Tei index compared to those with good reperfusion. METHODS AND RESULTS In 85 patients with first anteroseptal AMI, without other cardiac lesions such as prior myocardial infarction, LV hypertrophy or valvular disease, the Tei index was measured using Doppler echocardiography immediately after patients' arrival to the hospital, and the Thrombolysis in Myocardial Infarction (TIMI) grade was evaluated through subsequent coronary angiography. The Tei index was significantly greater in patients who did not have TIMI score of 3 compared to those with a TIMI of 3 (0.60+/-0.13 vs 0.46+/-0.06, p<0.0001). A Tei index >0.50 as the criteria for the absence of TIMI 3 had the sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of 75, 86, 94, 54 and 78%, respectively. CONCLUSION An increased Tei index suggests the absence of adequate coronary reperfusion in patients with first anterior AMI without other lesion.
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Affiliation(s)
- Eiji Kuwahara
- Department of Cardiovascular Medicine, Kagoshima University School of Medicine, Japan
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Meijer JM, Pieper PG, Drenthen W, Voors AA, Roos-Hesselink JW, van Dijk APJ, Mulder BJM, Ebels T, van Veldhuisen DJ. Pregnancy, fertility, and recurrence risk in corrected tetralogy of Fallot. Heart 2005; 91:801-5. [PMID: 15894783 PMCID: PMC1768963 DOI: 10.1136/hrt.2004.034108] [Citation(s) in RCA: 58] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVE To determine in women with surgically corrected tetralogy of Fallot the risk of pregnancy for mother and fetus, whether fertility was compromised, and the recurrence risk of congenital heart disease. DESIGN Data were collected from 83 patients through interviews and review of medical records. RESULTS In 29 patients 63 pregnancies were observed, of which 13 ended in an abortion. Fifty successful pregnancies were observed in 26 patients. During six successful pregnancies (12%) complications (symptomatic right sided heart failure, arrhythmias, or both) occurred. Both patients who developed symptomatic heart failure had severe pulmonary regurgitation. No clear relation between offspring mortality, premature birth or being small for gestational age, and cardiac characteristics of the mother was identified. Fifty seven patients were childless (41 (72%) voluntarily). Recurrence risk for congenital heart disease was 2.2%. Infertility was uncommon. CONCLUSIONS Although complications did occur in five of 26 (19%) of the patients with a corrected tetralogy of Fallot, pregnancy was generally well tolerated in this largest report so far. No obvious predictors for maternal events or child outcome were determined, except for a possible relation between severe pulmonary regurgitation and symptomatic heart failure.
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Affiliation(s)
- J M Meijer
- Department of Cardiology of the University Hospital Groningen, Groningen, The Netherlands
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Yu B, Otsuji Y, Yoshifuku S, Ikeda Y, Kamogawa Y, Yuasa T, Kuwahara E, Takasaki K, Uemura T, Nakashiki K, Miyata M, Hamasaki S, Biro S, Minagoe S, Tei C. Prediction of Prognosis in the UM-X7.1 Hamster Model of Congestive Heart Failure Using the Tei Index. Circ J 2005; 69:991-3. [PMID: 16041173 DOI: 10.1253/circj.69.991] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Cardiac function is difficult to evaluate in small animal models of heart disease. The Doppler Tei index is a simple and non-invasive measure that can express global cardiac function even in small animal models of congestive heart failure. However, its ability to predict prognosis has not been evaluated. METHODS AND RESULTS We tested the hypothesis that cardiac functional indices, such as the Tei index, can predict the prognosis of hamsters with cardiac dysfunction. The Tei index, defined as the sum of the isovolume contraction and relaxation time divided by ejection time, and the percent fractional shortening of the left ventricle was measured in 48 anesthetized male hamsters (19.7+/-0.4 weeks old) with cardiac dysfunction (UM-X7.1), using Doppler and 2-dimensional echocardiography. The hamsters were separated into 2 groups based on the median Tei index (0.50) and % fractional shortening (FS) (21%). Kaplan-Meier analysis determined the survival rates of the groups. Both the Tei index and %FS enabled significant distinction of better and poorer survival (p < 0.01), and the survival curves were less overlapped when the animals were separated according to the Tei index. CONCLUSION The Tei index can predict prognosis in a small animal model of heart failure.
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Affiliation(s)
- Bo Yu
- Department of Cardiovascular, Respiratory and Metabolic Medicine, Graduate School of Medicine, Kagoshima University, Kagoshima, Japan
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Fernandez CL, Kuczkowski KM. "Once a tetralogy of Fallot patient--always a tetralogy of Fallot patient (?)": time for reconsideration? ACTA ACUST UNITED AC 2004; 23:1107-8. [PMID: 15581729 DOI: 10.1016/j.annfar.2004.10.020] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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12
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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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