A011 Performance of CARPREG, ZAHARA and MWHO Risk Scores for Predicting Cardiovascular and Offspring Adverse Outcomes in Pregnancies of Patients With Congenital Heart Disease

Abstract

Background: Transposition of the great arteries (TGA) is a complex congenital heart problem that requires regular monitoring in Adult Congenital Heart Disease (ACHD) clinics. We wanted to assess the demographics of our patients, their outcomes, and their follow up, compared to international monitoring guidelines.Method: We retrospectively collected data for patients .16 years old with TGA in the 3DHB region, utilising the electronic health record. We recorded demographics and outcomes and the frequency of monitoring, from 2010 to 2019, compared with monitoring recommendations from the 2018 American College of Cardiology Guidelines (ACC) for management of ACHD.Results: 52 adults were identified with TGA. The mean age was 29 years (range 17 to 56), with 16 (31%) female. 46 had D-TGA, with 34 having an arterial switch (ASO), 10 an atrial switch, and 2 a Rastelli procedure as their initial surgery. 6 women had a total of 9 successful pregnancies. In assessing the adequacy of monitoring, patients were seen by a cardiologist within the recommended time frame 62% of the time. The ACC ACHD imaging frequency guidelines were met 50% of the time. However, exercise testing in TGA with ASO (6%) and holter monitoring in D-TGA with atrial switch (0%), were significantly underperformed.Conclusion: Patients with TGA within 3DHB have demographic features similar to other cohorts. The monitoring of our patients is deficient in a number of areas and the information will allow us to address these deficiencies and adjust our follow up accordingly.

Cardiogenic shock in pregnancy

“…For patients known to be at risk of developing CS during pregnancy, established risk stratification models, such as the CARdiac disease in PREGnancy risk scores I and II (CARPREG I and II), Zwangerschap bij Aangeboren HARtAfwijkingen I (ZAHARA) and the Modified World Health Organization Classification of Maternal Cardiovascular Risk (mWHO), have been developed to aid pregnancy counselling and management in women with known congenital and acquired cardiac disease. All these tools are useful for predicting cardiac events in these women 51–54 . As a result, few women are advised to absolutely avoid pregnancy, and instead they are supported in optimising their pre‐pregnancy cardiac function and receive regular clinical review during pregnancy to guide medical management and delivery 55 .…”

“…All these tools are useful for predicting cardiac events in these women. [51][52][53][54] As a result, few women are advised to absolutely avoid pregnancy, and instead they are supported in optimising their pre-pregnancy cardiac function and receive regular clinical review during pregnancy to guide medical management and delivery. 55 However, despite an improvement in overall clinical outcomes in pregnancy for patients with known heart disease in the last decade, specific cardiac conditions still pose significant risk.…”