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Koziol KJ, Isath A, Aronow WS, Frishman W, Ranjan P. Cyanotic Congenital Heart Disease in Pregnancy: A Review of Pathophysiology and Management. Cardiol Rev 2024; 32:348-355. [PMID: 36716356 DOI: 10.1097/crd.0000000000000512] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
The advancement of medical treatment and surgical technique, along with the invention of cardiopulmonary bypass, has allowed for long-term survival of patients with cyanotic congenital heart disease (CHD)-with many women with CHD now reaching child-bearing age and wishing to become pregnant. Pregnancy in these women is a major concern as the physiologic adaptations of pregnancy, including an increased circulating volume, increased cardiac output, reduced systemic vascular resistance, and decreased blood pressure, place a substantial load on the cardiovascular system. These changes are essential to meet the increased maternal and fetal metabolic demands and allow for sufficient placental circulation during gestation. However, in women with underlying structural heart conditions, they place an additional hemodynamic burden on the maternal body. Overall, with appropriate risk stratification, pre-conception counseling, and management by specialized cardiologists and high-risk obstetricians, most women with surgically corrected CHDs are expected to carry healthy pregnancies to term with optimization of both maternal and fetal risks. In this article, we describe the current understanding of 5 cyanotic CHDs-Tetralogy of Fallot, Transposition of the Great Arteries, Truncus Arteriosus, Ebstein's Anomaly, and Eisenmenger Syndrome-and explore the specific hemodynamic consequences, maternal and fetal risks, current guidelines, and outcomes of pregnancy in women with these conditions.
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Affiliation(s)
- Klaudia J Koziol
- From the New York Medical College, School of Medicine, Valhalla, NY
| | - Ameesh Isath
- Department of Cardiology, Westchester Medical Center, New York Medical College, Valhalla, NY
| | - Wilbert S Aronow
- From the New York Medical College, School of Medicine, Valhalla, NY
- Department of Cardiology, Westchester Medical Center, New York Medical College, Valhalla, NY
| | - William Frishman
- From the New York Medical College, School of Medicine, Valhalla, NY
- Department of Cardiology, Westchester Medical Center, New York Medical College, Valhalla, NY
| | - Pragya Ranjan
- From the New York Medical College, School of Medicine, Valhalla, NY
- Department of Cardiology, Westchester Medical Center, New York Medical College, Valhalla, NY
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Ichii N, Kakinuma T, Fujikawa A, Takeda M, Ohta T, Kagimoto M, Kaneko A, Izumi R, Kakinuma K, Saito K, Maeyama A, Yanagida K, Takeshima N, Ohwada M. Diagnosed corrected transposition of great arteries after cesarean section: A case report. World J Clin Cases 2022; 10:9821-9827. [PMID: 36186208 PMCID: PMC9516933 DOI: 10.12998/wjcc.v10.i27.9821] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2022] [Revised: 06/17/2022] [Accepted: 08/21/2022] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Corrected transposition of the great arteries (cTGA) is a cardiac malformation in which the ventricular and arterial-ventricular positions in the heart are doubly reversed. In general, this defect puts a load on the systemic circulation and causes heart failure, resulting in a poor prognosis. This article reports a case of cTGA detected in a patient with post-caesarean pregnancy who had undergone elective caesarean section and was experiencing an episode of acute heart failure.
CASE SUMMARY This was the case of a 36-year-old gravida 3 para 1 woman. No problems were noted in the puerperal course following the previous pregnancy. The current pregnancy was also uneventful. An elective caesarean section was performed and the patient was discharged from the hospital 7 d after the operation. On postoperative day 18, the patient became aware of breathing difficulty and presented at a nearby clinic, where she was referred to our institution after bilateral pleural effusions were detected. She was then diagnosed with acute heart failure after noting the presence of a prominent pedal oedema and SpO2 91% (supine position and room air); the patient was promptly hospitalised for close examination and treatment. Although chest computed tomography revealed the presence of cTGA, no other cardiac malformations were observed. Owing to improvements in both the pedal oedema and pleural effusions, the patient was discharged on day 9.
CONCLUSION Close examination should be performed on the premise of congenital cardiac malformation when heart failure symptoms are noted during perinatal control.
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Affiliation(s)
- Naoki Ichii
- Department of Obstetrics and Gynecology, International University of Health and Welfare Hospital, Tochigi 329-2763, Japan
| | - Toshiyuki Kakinuma
- Department of Obstetrics and Gynecology, International University of Health and Welfare Hospital, Tochigi 329-2763, Japan
| | - Atsushi Fujikawa
- Department of Cardiovascular Medicine, International University of Health and Welfare Hospital, Tochigi 329-2763, Japan
| | - Morihiko Takeda
- Department of Cardiovascular Medicine, International University of Health and Welfare Hospital, Tochigi 329-2763, Japan
| | - Tomoyuki Ohta
- Department of Radiology, International University of Health and Welfare Hospital, Tochigi 329-2763, Japan
| | - Masataka Kagimoto
- Department of Obstetrics and Gynecology, International University of Health and Welfare Hospital, Tochigi 329-2763, Japan
| | - Ayaka Kaneko
- Department of Obstetrics and Gynecology, International University of Health and Welfare Hospital, Tochigi 329-2763, Japan
| | - Ryo Izumi
- Department of Obstetrics and Gynecology, International University of Health and Welfare Hospital, Tochigi 329-2763, Japan
| | - Kaoru Kakinuma
- Department of Obstetrics and Gynecology, International University of Health and Welfare Hospital, Tochigi 329-2763, Japan
| | - Koyomi Saito
- Department of Obstetrics and Gynecology, International University of Health and Welfare Hospital, Tochigi 329-2763, Japan
| | - Asako Maeyama
- Department of Obstetrics and Gynecology, International University of Health and Welfare Hospital, Tochigi 329-2763, Japan
| | - Kaoru Yanagida
- Department of Obstetrics and Gynecology, International University of Health and Welfare Hospital, Tochigi 329-2763, Japan
| | - Nobuhiro Takeshima
- Department of Obstetrics and Gynecology, International University of Health and Welfare Hospital, Tochigi 329-2763, Japan
| | - Michitaka Ohwada
- Department of Obstetrics and Gynecology, International University of Health and Welfare Hospital, Tochigi 329-2763, Japan
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Yamamura K, Duarte V, Karur GR, Graf J, Hanneman K, Geva T, Valente AM, Wald RM. The impact of pulmonary valve replacement on pregnancy outcomes in women with tetralogy of Fallot. Int J Cardiol 2021; 330:43-49. [PMID: 33571563 DOI: 10.1016/j.ijcard.2021.02.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2020] [Revised: 01/29/2021] [Accepted: 02/03/2021] [Indexed: 11/16/2022]
Abstract
BACKGROUND Pregnant women with repaired tetralogy of Fallot (rTOF) are at increased risk of adverse outcomes. Although pre-pregnancy pulmonary valve replacement (PVR) may be considered in some women to attenuate risk, published data to support this practice are lacking. Our objective was to explore the impact of pre-pregnancy PVR on pregnancy outcomes in rTOF. METHODS Women with rTOF and cardiovascular magnetic resonance imaging (CMR) before and after pregnancy were included if CMR studies were completed within 3 years of pregnancy. Subjects were compared according to presence (+) or absence (-) of PVR at pre-pregnancy CMR. Pregnancy outcomes (cardiovascular, obstetric, and fetal/neonatal) were documented. RESULTS Of the 29 study women identified, 7 were PVR+ and 22 were PVR-. Post-pregnancy, the PVR- group demonstrated interval increase in indexed right ventricular end-diastolic volumes (RVEDVi) (157 ± 28 versus 166 ± 33 ml/m2, p = 0.003) and end-systolic volumes (RVESVi) (82 ± 17 versus 89 ± 20 ml/m2, p = 0.003) as compared with pre-pregnancy, but no significant change in RV ejection fraction, RV mass, or left ventricular measurements. In the PVR+ group, there were no interval changes in RV measurements pre-versus post pregnancy. Interval rate of change in RVESVi of PVR- exceeded PVR+ women (+3.7 ± 5.0 versus -2.2 ± 5.0 ml/m2/year, p = 0.03). Pregnancy outcomes did not differ in PVR+ versus PVR- women. CONCLUSIONS Pregnancy outcomes did not differ according to PVR status in our cohort. While RV volumes remained unchanged in PVR+ women, interval RV dilation was observed in PVR- women. Additional study of a larger population with longer follow-up may further inform clinical practice regarding pre-pregnancy PVR.
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Affiliation(s)
- Kenichiro Yamamura
- University Health Network and Mount Sinai Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Valeria Duarte
- Boston Children's Hospital, Department of Cardiology, Harvard Medical School, Boston, MA, USA
| | - Gauri Rani Karur
- Joint Department of Medical Imaging, University of Toronto, Toronto, Ontario, Canada
| | - Julia Graf
- Boston Children's Hospital, Department of Cardiology, Harvard Medical School, Boston, MA, USA
| | - Kate Hanneman
- Joint Department of Medical Imaging, University of Toronto, Toronto, Ontario, Canada
| | - Tal Geva
- Boston Children's Hospital, Department of Cardiology, Harvard Medical School, Boston, MA, USA
| | - Anne Marie Valente
- Boston Children's Hospital, Department of Cardiology, Harvard Medical School, Boston, MA, USA; Brigham and Women's Hospital, Department of Medicine, Boston, MA, USA
| | - Rachel M Wald
- University Health Network and Mount Sinai Hospital, University of Toronto, Toronto, Ontario, Canada; Joint Department of Medical Imaging, University of Toronto, Toronto, Ontario, Canada.
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Pregnancy in tetralogy of fallot: When and where. INTERNATIONAL JOURNAL OF CARDIOLOGY CONGENITAL HEART DISEASE 2021. [DOI: 10.1016/j.ijcchd.2021.100093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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Baris L, Ladouceur M, Johnson MR, Kozelj M, Festa P, Caruana M, Chee KH, Gilljam T, Ortiz EM, Duvekot JJ, Hall R, Roos-Hesselink JW. Pregnancy in Tetralogy of Fallot data from the ESC EORP ROPAC registry. INTERNATIONAL JOURNAL OF CARDIOLOGY CONGENITAL HEART DISEASE 2021. [DOI: 10.1016/j.ijcchd.2020.100059] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
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Keepanasseril A, Raj A, Plakkal N, Satheesh S, Pillai AA, Kundra P. Maternal and perinatal outcomes of pregnant women with tetralogy of Fallot: a tertiary center experience from south-India. J Matern Fetal Neonatal Med 2020; 35:3483-3488. [PMID: 32954868 DOI: 10.1080/14767058.2020.1822315] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
BACKGROUND Women with tetralogy of Fallot especially uncorrected are at increased risk of adverse maternal and perinatal outcomes. METHOD We reviewed the maternal complications and pregnancy outcomes of women with tetralogy of Fallot (ToF), having corrected or uncorrected lesion during the period from 2011 to 2019 attending a south-Indian tertiary care center. Data regarding demographics, clinical course, and medications received and echocardiographic diagnosis regarding ToF, labor and delivery details, and postpartum follow-up was collected from the records. For each case, four women matched for age (±2 years), without a diagnosis of heart disease, were included as controls. We compared the outcomes in pregnant women with ToF and controls as well between those who have undergone repair with those without repair and also with the controls. RESULTS There were 27 pregnancies in 19 patients with ToF, including eight pregnancies in seven women with uncorrected lesions. There was no maternal death or occurrence of infective endocarditis. Women with uncorrected lesion had significantly higher rates of fetal growth restriction (37.5% vs 6.7%), preterm birth (50% vs. 13.3%) resulting in lower birth weight (1907.5 g vs. 2607.3 g)) compared to those with a corrected lesion. Women with corrected lesion had similar outcomes to the controls (p > .5). CONCLUSION Women with uncorrected ToF are at increased risk of perinatal complications compared to those with corrected lesion and require care under a multidisciplinary team, with an individualized plan for delivery to optimize the outcomes.
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Affiliation(s)
- Anish Keepanasseril
- Department of Obstetrics and Gynaecology, Jawaharlal Institute of Post-graduate Medical Education and Research (JIPMER), Puducherry, India
| | - Ashwini Raj
- Department of Obstetrics and Gynaecology, Jawaharlal Institute of Post-graduate Medical Education and Research (JIPMER), Puducherry, India
| | - Nishad Plakkal
- Department of Neonatology, Jawaharlal Institute of Post-graduate Medical Education and Research (JIPMER), Puducherry, India
| | - Santhosh Satheesh
- Department of Cardiology, Jawaharlal Institute of Post-graduate Medical Education and Research (JIPMER), Puducherry, India
| | - Ajith Ananthakrishna Pillai
- Department of Cardiology, Jawaharlal Institute of Post-graduate Medical Education and Research (JIPMER), Puducherry, India
| | - Pankaj Kundra
- Department of Anaesthesiology and Critical Care, Jawaharlal Institute of Post-graduate Medical Education and Research (JIPMER), Puducherry, India
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Does pregnancy impact subsequent health outcomes in the maternal Fontan circulation? Int J Cardiol 2020; 301:67-73. [DOI: 10.1016/j.ijcard.2019.08.039] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2019] [Revised: 07/16/2019] [Accepted: 08/14/2019] [Indexed: 11/23/2022]
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Horiuchi C, Kamiya CA, Ohuchi H, Miyoshi T, Tsuritani M, Iwanaga N, Neki R, Niwa K, Kurosaki K, Ichikawa H, Ikeda T, Yoshimatsu J. Pregnancy outcomes and mid-term prognosis in women after arterial switch operation for dextro-transposition of the great arteries - Tertiary hospital experiences and review of literature. J Cardiol 2018; 73:247-254. [PMID: 30579805 DOI: 10.1016/j.jjcc.2018.11.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2018] [Revised: 11/03/2018] [Accepted: 11/10/2018] [Indexed: 10/27/2022]
Abstract
OBJECTIVE Arterial switch operation (ASO) for dextro-transposition of the great arteries (d-TGA) has gradually replaced the atrial switch operation and has become the standard operation. To date, the outcomes of pregnant women with d-TGA after this new operation have not been investigated. In this study, we investigated the impact of ASO on pregnant outcomes and mid-term prognosis in women with d-TGA and compared with the atrial switch operation through the literature review. METHODS AND RESULTS There were 20 pregnancies in 10 women with d-TGA after ASO and 6 resulted in abortion. Among 14 successful pregnancies in 10 women, 11 pregnancies achieved the term delivery and 3 pregnancies, including 1 twin pregnancy, resulted in preterm labor. Maternal cardiovascular events occurred in 4 (heart failure and arrhythmias in 3 and arrhythmia in 1), and all were controllable with medications. Risk factors for the peripartum cardiac events were older age at ASO and delivery, and higher concentration of brain natriuretic peptide (BNP) at first trimester (p<0.05). In 7-60 month-follow-up after delivery, no case showed deterioration of functional class and systemic ventricular function. According to the literature review, women after ASO demonstrated a better prognosis than those after the atrial switch operation. CONCLUSIONS The majority of women with d-TGA after ASO tolerated pregnancy and delivery well. The older age at ASO, an elderly pregnancy, and higher BNP levels at the first trimester were possibly risk factors of peripartum cardiovascular events among the group. The literature reviews and this study may indicate the advantage of systemic left ventricle compared with systemic right ventricle in long-term outcomes after delivery.
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Affiliation(s)
- Chinami Horiuchi
- Departments of Perinatology and Gynecology, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan; Departments of Obstetrics and Gynecology, Mie University School of Medicine, Mie, Japan.
| | - Chizuko A Kamiya
- Departments of Perinatology and Gynecology, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan
| | - Hideo Ohuchi
- Departments of Pediatric Cardiology, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan
| | - Takekazu Miyoshi
- Departments of Obstetrics and Gynecology, Mie University School of Medicine, Mie, Japan
| | - Mitsuhiro Tsuritani
- Departments of Perinatology and Gynecology, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan
| | - Naoko Iwanaga
- Departments of Perinatology and Gynecology, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan
| | - Reiko Neki
- Departments of Perinatology and Gynecology, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan
| | - Koichiro Niwa
- Cardiovascular Center, St. Luke's International Hospital, Tokyo, Japan
| | - Kenichi Kurosaki
- Departments of Pediatric Cardiology, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan
| | - Hajime Ichikawa
- Departments of Pediatric Cardiovascular Surgery, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan
| | - Tomoaki Ikeda
- Departments of Obstetrics and Gynecology, Mie University School of Medicine, Mie, Japan
| | - Jun Yoshimatsu
- Departments of Perinatology and Gynecology, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan
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Tanaka H, Kamiya C, Katsuragi S, Tanaka K, Yoshimatsu J, Ikeda T. Effect of epidural anesthesia in labor; pregnancy with cardiovascular disease. Taiwan J Obstet Gynecol 2018; 57:190-193. [PMID: 29673659 DOI: 10.1016/j.tjog.2018.02.004] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/05/2018] [Indexed: 10/17/2022] Open
Abstract
OBJECTIVE We studied the effect and safety of epidural anesthesia during labor in pregnant women with cardiovascular disease. MATERIALS AND METHODS In the pregnant women with cardiovascular disease, we compared maternal outcome and suppressive effect on blood pressure retrospectively between the epidural group (anesthetized epidurally during labor) and the no-epidural group (not anesthetized epidurally during labor). RESULTS A total of 277 patients were included in the analyses. Cardiovascular events decreased significantly in epidural group (P < 0.05). Cardiovascular events occurred in 12 (epidural group) and 2 (no-epidural group) of cases (P < 0.05). Cardiovascular events are all events related to arrhythmia. In the epidural group, the systolic blood pressure showed no increase in labor (110.5 mmHg, 95% CI; 95-132 mmHg vs. 110 mmHg, 95% CI; 91-130 mmHg). In the no-epidural group, the systolic blood pressure increased in labor (107 1 mmHg, 95% CI; 96-138 mmHg vs. 123 mmHg, 95% CI; 105-153 mmHg; P < 0.05). CONCLUSION Epidural anesthesia had decrease of the cardiovascular events related to arrhythmia and the effect of significantly suppression raising the blood pressure during labor in pregnant women with cardiovascular disease. In pregnant women with the cardiovascular disease, epidural anesthesia during labor may be available.
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Affiliation(s)
- Hiroaki Tanaka
- Department of Obstetrics and Gynecology, Mie University Faculty Medicine, Mie, Japan.
| | - Chizuko Kamiya
- Department of Perinatology, National Cerebral and Cardiovascular Center, Tokyo, Japan
| | - Shinji Katsuragi
- Department of Perinatology, National Cerebral and Cardiovascular Center, Tokyo, Japan
| | - Kayo Tanaka
- Department of Obstetrics and Gynecology, Mie University Faculty Medicine, Mie, Japan
| | - Jun Yoshimatsu
- Department of Perinatology, National Cerebral and Cardiovascular Center, Tokyo, Japan
| | - Tomoaki Ikeda
- Department of Obstetrics and Gynecology, Mie University Faculty Medicine, Mie, Japan
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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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11
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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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Tanaka H, Katsuragi S, Tanaka K, Iwanaga N, Yoshimatsu J, Takahashi JC, Ikeda T. Impact of pregnancy on the size of small cerebral aneurysm. J Matern Fetal Neonatal Med 2016; 30:2759-2762. [PMID: 27852140 DOI: 10.1080/14767058.2016.1262345] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
OBJECTIVE Because the management of cerebral aneurysms during pregnancy remains controversial, the objective of this study was to perform a retrospective review of pregnant women with cerebral aneurysms to determine whether pregnancy is a risk factor for aneurysm rupture. METHODS The change in size of aneurysms during pregnancy was examined by performing repeat magnetic resonance angiography in five pregnant women with cerebral aneurysms between 2005 and 2013. The outcome examined was development of subarachnoid hemorrhage. RESULTS Among the five pregnancies, there were eight cerebral aneurysms. Subarachnoid hemorrhage did not developed during any pregnancy. In four of the pregnancies, the cerebral aneurysms did not change in size during pregnancy, remaining 2-5 mm. Although in one pregnancy, the aneurysm increased from 6 to 7 mm during the third trimester, it returned to its original size in the postpartum period. CONCLUSIONS We suggest that if the cerebral aneurysm is small (≤ 5 mm), it is likely to remain unchanged despite the increase in circulating blood volume during pregnancy. Cerebral aneurysms greater than 5 mm but without blebs, irregular shape, high-risk location, or increased aspect ratio are also at low risk of rupture and are not likely to change during pregnancy.
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Affiliation(s)
- Hiroaki Tanaka
- a Department of Perinatology and Gynecology , National Cerebral and Cardiovascular Center , Osaka , Japan.,b Department of Obstetrics and Gynecology , Mie University School of Medicine , Mie , Japan
| | - Shinji Katsuragi
- a Department of Perinatology and Gynecology , National Cerebral and Cardiovascular Center , Osaka , Japan
| | - Kayo Tanaka
- a Department of Perinatology and Gynecology , National Cerebral and Cardiovascular Center , Osaka , Japan.,b Department of Obstetrics and Gynecology , Mie University School of Medicine , Mie , Japan
| | - Naoko Iwanaga
- a Department of Perinatology and Gynecology , National Cerebral and Cardiovascular Center , Osaka , Japan
| | - Jun Yoshimatsu
- a Department of Perinatology and Gynecology , National Cerebral and Cardiovascular Center , Osaka , Japan
| | - Jun C Takahashi
- c Department of Neurosugery , National Cerebral and Cardiovascular Center , Osaka , Japan
| | - Tomoaki Ikeda
- b Department of Obstetrics and Gynecology , Mie University School of Medicine , Mie , Japan
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Kampman MAM, Valente MAE, van Melle JP, Balci A, Roos-Hesselink JW, Mulder BJM, van Dijk APJ, Oudijk MA, Jongbloed MRM, van Veldhuisen DJ, Pieper PG. Cardiac adaption during pregnancy in women with congenital heart disease and healthy women. Heart 2016; 102:1302-8. [DOI: 10.1136/heartjnl-2015-308946] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2015] [Accepted: 03/09/2016] [Indexed: 11/03/2022] Open
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14
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Tanaka H, Katsuragi S, Osato K, Hasegawa J, Nakata M, Murakoshi T, Yoshimatsu J, Sekizawa A, Kanayama N, Ishiwata I, Ikeda T. The increase in the rate of maternal deaths related to cardiovascular disease in Japan from 1991-1992 to 2010-2012. J Cardiol 2016; 69:74-78. [PMID: 26899278 DOI: 10.1016/j.jjcc.2016.01.005] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2015] [Revised: 12/30/2015] [Accepted: 01/10/2016] [Indexed: 11/26/2022]
Abstract
BACKGROUND Cardiovascular diseases (CVD), both genetic and acquired, increase the risk of maternal death (MD) unless proper genetic/clinical counseling is provided and a multidisciplinary approach is adopted during pregnancy. In recent decades, there has been a significant increase in the number of women with CVD of child-bearing age and in the incidence of pregnancy among relatively older women. However, the impact of this phenomenon on MD has not been carefully investigated. METHODS This retrospective study compares the incidence and etiology of maternal deaths related to cardiovascular disease (MD-CVD) in Japan in 2010-2012 to that seen in 1991-1992. RESULTS Seven cases of MD-CVD were reported in 1991-1992, compared to 15 in 2010-2012. In 2010-2012, the causes included aortic dissection (n=5), peripartum cardiomyopathy (n=3), sudden adult/arrhythmic death syndrome (n=2), acute cardiomyopathy (n=2), pulmonary hypertension (n=2), and myocardial infarction (n=1), and four of these causes were not encountered in 1991-1992. The incidence of MD over the total number of pregnancies decreased from 9.4 per 100,000 cases in 1990-1992 to 4.6 per 100,000 cases in 2010-2012 (p<0.05). However, the incidence of MD-CVD over the number of cases of MD increased from 2.9% in 1991-1992 to 9.7% in 2010-2012 (p<0.05). CONCLUSIONS The present study demonstrates that the rate of MD-CVD among the cases of MD has increased 3-fold in Japan over the past 20 years. Thus, it is of critical importance to better understand the etiologies and early signs of MD-CVD and to devise an effective management program for pregnancies complicated by CVD.
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Affiliation(s)
- Hiroaki Tanaka
- Department of Obstetrics and Gynecology, Mie University School of Medicine, Mie, Japan.
| | - Shinji Katsuragi
- Department of Obstetrics and Gynecology, Sakakibara Heart Institute, Tokyo, Japan
| | - Kazuhiro Osato
- Department of Obstetrics and Gynecology, Ise Red Cross Hospital, Mie, Japan
| | - Junichi Hasegawa
- Department of Obstetrics and Gynecology, Showa University School of Medicine, Tokyo, Japan
| | - Masahiko Nakata
- Department of Obstetrics and Gynecology, Toho University Omori Medical Center, Tokyo, Japan
| | - Takeshi Murakoshi
- Division of Perinatology, Maternal and Perinatal Care Center, Seirei Hamamatsu General Hospital, Hamamatsu, Japan
| | - Jun Yoshimatsu
- Division of Maternal Fetal Medicine and Gynecology, National Cerebral and Cardiovascular Center, Osaka, Japan
| | - Akihiko Sekizawa
- Department of Obstetrics and Gynecology, Showa University School of Medicine, Tokyo, Japan
| | - Naohiro Kanayama
- Department of Obstetrics and Gynecology, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Isamu Ishiwata
- Ishiwata Obstetrics and Gynecology Hospital, Ibaraki, Japan
| | - Tomoaki Ikeda
- Department of Obstetrics and Gynecology, Mie University School of Medicine, Mie, Japan
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15
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Abstract
Most women with known congenital heart disease can have successful pregnancy, labor, and delivery. Preconception assessment is essential in understanding anatomy, repairs, and current physiology, all of which can influence risk in pregnancy. With that foundation, a multidisciplinary cardio-obstetric team can predict and prepare for complications that may occur with superimposed hemodynamic changes of pregnancy. Individuals with Eisenmenger syndrome, pulmonary hypertension, cyanosis, significant left heart obstruction, ventricular dysfunction, or prior major cardiac event are among the highest risk for complications.
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Tanaka H, Katsuragi S, Tanaka K, Sawada M, Iwanaga N, Yoshimatsu J, Ikeda T. Maternal and neonatal outcomes in labor and at delivery when long QT syndrome is present. J Matern Fetal Neonatal Med 2015; 29:1117-9. [PMID: 25902397 DOI: 10.3109/14767058.2015.1036023] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE Women during labor may be susceptible to torsades de pointes (TdP), which may cause the fetal condition to deteriorate. The aim of the present investigation was to analyze maternal and fetal outcomes during labor when long QT syndrome (LQTS) was present. METHODS We examined the maternal and neonatal outcomes of 25 pregnancies (18 women) with LQT between 1995 and 2012 at the Department of Perinatology, National Cardiovascular Center, Japan. Maternal and neonatal outcomes including cardiovascular events, cardiovascular events within a week after delivery, caesarean delivery rate, still births, preterm births, and non-reassuring fetal heart rate pattern (NRFHR) during labor were investigated. RESULTS All the mothers survived, and no cardiovascular events occurred in labor or postpartum due to LQTS in either vaginal delivery or caesarean delivery. A total of 23 women (92%) had used beta blockers in this study. Caesarean delivery was performed due to NRFHR during labor in 5 pregnancies (20%). CONCLUSION Delivery when LQTS is present has a low likelihood of cardiovascular events, but pregnancy with LQTS had a higher caesarean delivery rate due to NRFHR in labor. Most women used beta blockers in this study, and it is possible that beta blocker use prevents cardiovascular events during labor. NRFHR during labor may be related with inherited LQT through the mother.
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Affiliation(s)
- Hiroaki Tanaka
- a Department of Perinatology , National Cerebral and Cardiovascular Center , Suita , Osaka , Japan and.,b Department of Obstetrics and Gynecology , Mie University Faculty Medicine , Tsu , Japan
| | - Shinji Katsuragi
- a Department of Perinatology , National Cerebral and Cardiovascular Center , Suita , Osaka , Japan and
| | - Kayo Tanaka
- a Department of Perinatology , National Cerebral and Cardiovascular Center , Suita , Osaka , Japan and
| | - Masami Sawada
- a Department of Perinatology , National Cerebral and Cardiovascular Center , Suita , Osaka , Japan and
| | - Naoko Iwanaga
- a Department of Perinatology , National Cerebral and Cardiovascular Center , Suita , Osaka , Japan and
| | - Jun Yoshimatsu
- a Department of Perinatology , National Cerebral and Cardiovascular Center , Suita , Osaka , Japan and
| | - Tomoaki Ikeda
- b Department of Obstetrics and Gynecology , Mie University Faculty Medicine , Tsu , Japan
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17
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Kampman MA, Balci A, Groen H, van Dijk AP, Roos-Hesselink JW, van Melle JP, Sollie-Szarynska KM, Wajon EM, Mulder BJ, van Veldhuisen DJ, Pieper PG. Cardiac function and cardiac events 1-year postpartum in women with congenital heart disease. Am Heart J 2015; 169:298-304. [PMID: 25641540 DOI: 10.1016/j.ahj.2014.11.010] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2014] [Accepted: 11/09/2014] [Indexed: 02/01/2023]
Abstract
BACKGROUND Pregnancy is increasingly common in women with congenital heart disease (CHD), but little is known about long-term cardiovascular outcome after pregnancy in these patients. We studied the incidence of cardiovascular events 1-year postpartum and compared cardiac function prepregnancy and 1-year postpartum in women with CHD. METHODS From our national, prospective multicenter cohort study, 172 women were studied. Follow-up with clinical evaluation and echocardiography and NT-proBNP measurement were performed during pregnancy and 12 months postpartum. Cardiovascular events were defined as need for an urgent invasive cardiovascular procedure, heart failure, arrhythmia, thromboembolic events, myocardial infarction, cardiac arrest, cardiac death, endocarditis, and aortic dissection. RESULTS Cardiovascular events were observed after 11 pregnancies (6.4%). Women with cardiovascular events postpartum had significant higher NT-proBNP values at 20-week gestation (191 [137-288] vs 102.5 [57-167]; P = .049) and 1-year postpartum compared with women without cardiovascular events postpartum (306 [129-592] vs 105 [54-187] pg/mL; P = .014). Women with cardiovascular events during pregnancy were at higher risk for late cardiovascular events (HR 7.1; 95% CI 2.0-25.3; P = .003). In women with cardiovascular events during pregnancy, subpulmonary end-diastolic diameter had significantly increased 1-year postpartum (39.0 [36.0-48.0] to 44.0 [40.0-50.0]; P = .028). No other significant differences were found in cardiac function or size 1-year postpartum compared with preconception values. CONCLUSIONS Cardiovascular events are relatively rare 1 year after pregnancy in women with CHD. Women with cardiovascular events during pregnancy are prone to develop cardiovascular events 1-year postpartum and have increased subpulmonary ventricular diameter compared with preconception values.
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18
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Tanaka H, Kamiya C, Katsuragi S, Tanaka K, Miyoshi T, Tsuritani M, Yoshida M, Iwanaga N, Neki R, Yoshimatsu J, Ikeda T. Cardiovascular events in pregnancy with hypertrophic cardiomyopathy. Circ J 2014; 78:2501-6. [PMID: 25099604 DOI: 10.1253/circj.cj-14-0541] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND The influence of the physiological circulatory changes during pregnancy on hypertrophic cardiomyopathy (HCM) is unclear. There have been no comprehensive studies of pregnant women with HCM in the Japanese population. METHODS AND RESULTS A total of 27 pregnancies (23 women with HCM) were retrospectively reviewed. A total of 18 cardiovascular events occurred in 13 of the 27 pregnancies (48%), and 13 of these events (76%) were related to arrhythmia. The cardiovascular events tended to occur in the early stage of pregnancy (≈30 gestational weeks) or postpartum. The events related to arrhythmia mainly occurred in the early stage of pregnancy or at approximately 30 gestational weeks. Four pregnancies were terminated because of cardiovascular events. Cardiovascular events occurred in 8 of 9 pregnancies in women on medication before pregnancy (88%), 7 of 10 pregnancies with high CARPREG score (70%), and in 9 of 12 pregnancies with high ZAHARA score (75%). CONCLUSIONS Cardiovascular events occurred in more than half of the pregnant women complicated with HCM, and the arrhythmia is the most common cardiovascular event. Medication in the pre-pregnancy period, and CARPREG or ZAHARA score ≥1 were identified as risk factors of cardiac events during pregnancy or postpartum.
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Affiliation(s)
- Hiroaki Tanaka
- Department of Perinatology, National Cerebral and Cardiovascular Center
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19
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Abstract
As more women with repaired congenital heart disease survive to their reproductive years and many other women are delaying pregnancy until later in life, a rising concern is the risk of cardiac arrhythmias during pregnancy. Naturally occurring cardiovascular changes during pregnancy increase the likelihood that a recurrence of a previously experienced cardiac arrhythmia or a de novo arrhythmia will occur. Arrhythmias should be thoroughly investigated to determine if there is a reversible etiology, and risks/benefits of treatment options should be fully explored. We discuss the approach to working up and treating various arrhythmias during pregnancy with attention to fetal and maternal risks as well as treatment of fetal arrhythmias. Acute management in stable patients includes close monitoring and intravenous pharmacologic therapy, while DC cardioversion should be used to terminate arrhythmias in hemodynamically unstable patients. Long-term management may require continued oral antiarrhythmic therapy, with particular attention to fetal safety, to prevent complications associated with arrhythmias.
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Affiliation(s)
- Robert J Knotts
- Department of Medicine, Columbia University Medical Center, 161 Fort Washington Ave, Suite 648, New York, NY 10032
| | - Hasan Garan
- Department of Medicine, Columbia University Medical Center, 161 Fort Washington Ave, Suite 648, New York, NY 10032.
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20
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Rendón ID, Soto M, Jaramillo M, Palacio AC, Restrepo JA. Tetralogía de Fallot y embarazo. REVISTA COLOMBIANA DE CARDIOLOGÍA 2014. [DOI: 10.1016/j.rccar.2014.04.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
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21
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Boulé S, Ovart L, Marquié C, Botcherby E, Klug D, Kouakam C, Brigadeau F, Guédon-Moreau L, Wissocque L, Meurice J, Lacroix D, Kacet S. Pregnancy in women with an implantable cardioverter-defibrillator: is it safe? Europace 2014; 16:1587-94. [PMID: 24596396 DOI: 10.1093/europace/euu036] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
AIMS To describe obstetric/neonatal and cardiac outcomes for a cohort of women carrying implantable cardioverter-defibrillators (ICDs) during pregnancy. METHODS AND RESULTS All women in routine follow-up at our institution for ICD implantation who became pregnant between 2006 and 2013 were included in this study. All ICDs were pre-pectoral devices with bipolar endocardial leads. Obstetric/neonatal and cardiac outcomes were assessed during pregnancy and post-partum. Twenty pregnancies were conceived by 12 women carrying ICD devices, 14 of which resulted in live births and none in maternal death. Seven of these women had structural cardiomyopathies and five had channelopathies. No device-related complications were recorded. Twelve shocks (nine transthoracic and three from ICDs) were experienced during pregnancy by two women, one of whom miscarried shortly afterwards at 4 weeks gestation. One stillbirth, three miscarriages and one termination were recorded for women with long QT syndrome, repaired tetralogy of Fallot and repaired Laubry-Pezzi syndrome, respectively. Intrauterine growth restriction, low birth weight, and neonatal hypoglycaemia were recorded in four, three, and five pregnancies, respectively. CONCLUSIONS Pregnancy had no effect on ICD operation and no evidence was found to link ICD carriage with adverse pregnancy outcomes, although one miscarriage may have been induced by ICD shock therapy. A worsening of cardiac condition occurs in specific cardiac diseases and β-blocker therapy should be continued for all women carrying ICDs in pregnancy as the benefits outweigh the risks of taking this medication.
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Affiliation(s)
- Stéphane Boulé
- Department of Cardiovascular medicine, Lille University Hospital, Hôpital Cardiologique, CHRU, 59037 Lille, France
| | - Lionel Ovart
- Department of Cardiovascular medicine, Lille University Hospital, Hôpital Cardiologique, CHRU, 59037 Lille, France
| | - Christelle Marquié
- Department of Cardiovascular medicine, Lille University Hospital, Hôpital Cardiologique, CHRU, 59037 Lille, France
| | - Edward Botcherby
- Department of Cardiovascular medicine, Lille University Hospital, Hôpital Cardiologique, CHRU, 59037 Lille, France
| | - Didier Klug
- Department of Cardiovascular medicine, Lille University Hospital, Hôpital Cardiologique, CHRU, 59037 Lille, France Faculty of medicine, University of Lille 2, 59045 Lille, France
| | - Claude Kouakam
- Department of Cardiovascular medicine, Lille University Hospital, Hôpital Cardiologique, CHRU, 59037 Lille, France
| | - François Brigadeau
- Department of Cardiovascular medicine, Lille University Hospital, Hôpital Cardiologique, CHRU, 59037 Lille, France
| | - Laurence Guédon-Moreau
- Department of Cardiovascular medicine, Lille University Hospital, Hôpital Cardiologique, CHRU, 59037 Lille, France
| | - Ludivine Wissocque
- Department of Cardiovascular medicine, Lille University Hospital, Hôpital Cardiologique, CHRU, 59037 Lille, France Faculty of medicine, University of Lille 2, 59045 Lille, France
| | - Jonathan Meurice
- Department of Cardiovascular medicine, Lille University Hospital, Hôpital Cardiologique, CHRU, 59037 Lille, France
| | - Dominique Lacroix
- Department of Cardiovascular medicine, Lille University Hospital, Hôpital Cardiologique, CHRU, 59037 Lille, France Faculty of medicine, University of Lille 2, 59045 Lille, France
| | - Salem Kacet
- Department of Cardiovascular medicine, Lille University Hospital, Hôpital Cardiologique, CHRU, 59037 Lille, France Faculty of medicine, University of Lille 2, 59045 Lille, France
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22
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Tanaka H, Tanaka K, Kamiya C, Iwanaga N, Katsuragi S, Yoshimatsu J. Analysis of Anticoagulant Therapy by Unfractionated Heparin During Pregnancy After Mechanical Valve Replacement. Circ J 2014; 78:878-81. [DOI: 10.1253/circj.cj-13-1178] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Hiroaki Tanaka
- Department of Perinatology, National Cerebral and Cardiovascular Center
| | - Kayo Tanaka
- Department of Perinatology, National Cerebral and Cardiovascular Center
| | - Chizuko Kamiya
- Department of Perinatology, National Cerebral and Cardiovascular Center
| | - Naoko Iwanaga
- Department of Perinatology, National Cerebral and Cardiovascular Center
| | - Shinji Katsuragi
- Department of Perinatology, National Cerebral and Cardiovascular Center
| | - Jun Yoshimatsu
- Department of Perinatology, National Cerebral and Cardiovascular Center
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Hirono K, Sekine M, Shiba N, Hayashi S, Nakaoka H, Ibuki K, Saito K, Watanabe K, Ozawa S, Higuma T, Yoshimura N, Kitajima I, Ichida F. N-terminal pro-Brain Natriuretic Peptide as a Predictor of Reoperation in Children With Surgically Corrected Tetralogy of Fallot. Circ J 2014; 78:693-700. [DOI: 10.1253/circj.cj-13-1048] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Keiichi Hirono
- Department of Pediatrics, Graduate School of Medicine, University of Toyama
| | - Michikazu Sekine
- Department of Welfare Promotion and Epidemiology, Graduate School of Medicine, University of Toyama
| | - Noriko Shiba
- Department of Clinical Pharmacy, Graduate School of Medicine, University of Toyama
| | - Shirou Hayashi
- Department of Clinical Pharmacy, Graduate School of Medicine, University of Toyama
| | - Hideyuki Nakaoka
- Department of Pediatrics, Graduate School of Medicine, University of Toyama
| | - Keijiro Ibuki
- Department of Pediatrics, Graduate School of Medicine, University of Toyama
| | - Kazuyoshi Saito
- Department of Pediatrics, Graduate School of Medicine, University of Toyama
| | - Kazuhiro Watanabe
- Department of Pediatrics, Graduate School of Medicine, University of Toyama
| | - Sayaka Ozawa
- Department of Pediatrics, Graduate School of Medicine, University of Toyama
| | - Tomonori Higuma
- First Department of Surgery, Graduate School of Medicine, University of Toyama
| | - Naoki Yoshimura
- First Department of Surgery, Graduate School of Medicine, University of Toyama
| | - Isao Kitajima
- Department of Clinical Pharmacy, Graduate School of Medicine, University of Toyama
| | - Fukiko Ichida
- Department of Pediatrics, Graduate School of Medicine, University of Toyama
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25
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Trigas V, Nagdyman N, Pildner von Steinburg S, Oechslin E, Vogt M, Berger F, Schneider KTM, Ewert P, Hess J, Kaemmerer H. Pregnancy-Related Obstetric and Cardiologic Problems in Women After Atrial Switch Operation for Transposition of the Great Arteries. Circ J 2014; 78:443-9. [DOI: 10.1253/circj.cj-12-1051] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Vasiliki Trigas
- Department of Pediatric Cardiology and Congenital Heart Defects, German Heart Centre Munich
| | - Nicole Nagdyman
- Department of Congenital Heart Defects and Pediatric Cardiology, German Heart Centre Berlin
| | | | - Erwin Oechslin
- Toronto Congenital Cardiac Centre for Adults, Toronto General Hospital
| | - Manfred Vogt
- Department of Pediatric Cardiology and Congenital Heart Defects, German Heart Centre Munich
| | - Felix Berger
- Department of Congenital Heart Defects and Pediatric Cardiology, German Heart Centre Berlin
| | | | - Peter Ewert
- Department of Pediatric Cardiology and Congenital Heart Defects, German Heart Centre Munich
| | - John Hess
- Department of Pediatric Cardiology and Congenital Heart Defects, German Heart Centre Munich
| | - Harald Kaemmerer
- Department of Pediatric Cardiology and Congenital Heart Defects, German Heart Centre Munich
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26
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Higa T, Okura H, Tanemoto K, Yoshida K. Prosthetic valve thrombosis caused by heparin-induced thrombocytopenia thrombosis during pregnancy. Circ J 2013; 78:1004-5. [PMID: 24334636 DOI: 10.1253/circj.cj-13-0919] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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27
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Metz TD, Hayes SA, Garcia CY, Yetman AT. Impact of pregnancy on the cardiac health of women with prior surgeries for pulmonary valve anomalies. Am J Obstet Gynecol 2013; 209:370.e1-6. [PMID: 23685079 DOI: 10.1016/j.ajog.2013.05.029] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2013] [Revised: 04/27/2013] [Accepted: 05/13/2013] [Indexed: 10/26/2022]
Abstract
OBJECTIVE We assessed the impact of pregnancy on long-term cardiac outcomes in women with prior surgery for congenital pulmonary valve anomalies. STUDY DESIGN Data on all reproductive age women with prior pulmonary valve repair or replacement, cared for at a tertiary institution over a 10-year period, were analyzed. Kaplan-Meier curves and proportional hazards models were estimated to assess the impact of pregnancy and multiparity on a composite long-term adverse outcome defined as death, heart failure, or unanticipated cardiac surgery. Peripartum cardiac complications were also assessed. RESULTS Thirty-three parous and 20 nulliparous, nonpregnant controls with primary pulmonary valve replacement or repair were identified. Among the parous women, there were 95 pregnancies (median, 3.0; 1-10) resulting in 81 live births. Peripartum cardiac complications occurred in 28 (29.8%; 95% confidence interval, 20.4-39.2) of the pregnancies. A composite adverse long-term cardiac outcome occurred in 17 of 33 parous women, over 417 person-years (4 per 100 person-years) and 1 of 20 nulliparous women over 258 person-years (0.4 per 100 person-years); women with pregnancies were more likely at any point in time to have a composite long-term adverse cardiac outcome compared with nulliparous controls. Women with 2 or more pregnancies were more likely to have a composite adverse cardiac outcome than those with less than 2 pregnancies (hazard ratio, 8.8; 95% confidence interval, 1.5-50.3). CONCLUSION Peripartum cardiac complications are common in women with prior pulmonary valve repair or replacement. Pregnancy appears to increase the risk of long-term adverse cardiac outcomes in these patients when compared with nulliparous controls.
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Demirkol S, Balta S, Cakar M, Arslan Z, Unlu M. Do we just assess the left ventricle in pregnant women with structural heart disease? Int J Cardiol 2013; 168:591. [DOI: 10.1016/j.ijcard.2013.01.243] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2012] [Accepted: 01/18/2013] [Indexed: 11/30/2022]
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29
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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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30
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Long-term management of adults with conotruncal lesions: the diagnostic approach at All Children's Hospital. Cardiol Young 2012; 22:768-79. [PMID: 23331601 DOI: 10.1017/s104795111200203x] [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: 11/07/2022]
Abstract
Improved survival in children with complex congenital cardiac disease, such as conotruncal abnormalities, has created a sub-population of children and young adults who need comprehensive multi-disciplinary long-term follow-up. Routine surveillance with comprehensive screening for structural heart disease, functional heart disease, thromboembolic disease, arrhythmias, and associated end-organ dysfunction is important. Future research will better define the care plans for routine surveillance in patients with conotruncal abnormalities.
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