Outcomes of pregnancy in women with tetralogy of fallot

Veldtman, Gruschen; Connolly, Heidi M.; Grogan, Martha; Ammash, Naser M.; Warnes, Carole A.

doi:10.1016/j.jacc.2003.11.067

Cited by 211 publications

(121 citation statements)

References 16 publications

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“…Patients with TOF have an increased risk of fetal loss, and their babies are more likely to have congenital anomalies. 5 For management of ToF, there is no literature which recommends repairing process of cardiac anomalies during pregnancy. Therefore, the only way to overcome this problem is by managing the pregnancy medically.…”

Section: Discussionmentioning

confidence: 99%

Peripartum cardiomyopathy in uncorrected tetralogy of fallot: a case report

Phutane

Kal²,

Patil

et al. 2018

Int J Reprod Contracept Obstet Gynecol

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Tetralogy of Fallot (ToF) is the most common cyanotic congenital heart with incidence about 10% of all congenital heart disease. Natural survival to the fourth decade is extremely rare (only about 3%), but there is a tendency of increasing number of women with cyanotic congenital heart disease living 3 to 4 decades and are becoming pregnant. Because of significant physiology adaptation and changes, pregnancy and delivery process are troublesome for most unhealthy women, including those with uncorrected ToF. For ToF patients, it remains an important cause of maternal morbidity (62.5%), and even mortality (10%) and has significant effects on fetal outcome. Discussed below a case of pregnancy in a 30 year old woman with uncorrected ToF, dyspnoea class II of New York Heart Association, on 36th week pregnancy with complication of postpartum cardiomyopathy. Through dedicated medical care, patient's condition improvement can be seen. Prognosis of pregnancy in patient with uncorrected ToF is poor without optimal obstetrical and medical management.

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Section: Discussionmentioning

confidence: 99%

Peripartum cardiomyopathy in uncorrected tetralogy of fallot: a case report

Phutane

Kal²,

Patil

et al. 2018

Int J Reprod Contracept Obstet Gynecol

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“…Right ventricular failure, arrhythmias, progressive tricuspid valve regurgitation, and sudden cardiac death may all result. 3 In palliation, the modified BTS utilizes a polytetrafluoroethylene graft interposed between the subclavian artery and the pulmonary artery. This increases the volume of blood entering the pulmonary vasculature; however, it rarely causes overperfusion.…”

Section: Discussionmentioning

confidence: 99%

“…1 The literature contains many cases of successful pregnancy outcomes in patients with corrected TOF. 2,3 As there is little resultant hemodynamic compromise, management is typically similar to that of the healthy parturient. Pregnancy in women with uncorrected TOF, however, has a maternal mortality rate (MMR) as high as 12%.…”

Section: Résumémentioning

confidence: 99%

Cardiac output monitoring during Cesarean delivery in a patient with palliated tetralogy of Fallot

Clivatti

Smith

Sermer

et al. 2012

Can J Anesth/J Can Anesth

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Purpose Tetralogy of Fallot (TOF) is one of the most common causes of cyanotic congenital heart disease. The anesthetic management of parturients with uncorrected TOF is challenging and controversial, especially for Cesarean delivery (CD). We describe the use of noninvasive cardiac output (CO) monitoring to assist the management of CD for a woman with palliated TOF under general anesthesia. Clinical features A 34-yr-old woman presented for elective CD at 38 weeks gestation. Having been born with TOF, she underwent a modified Blalock-Taussig shunt at six years of age, followed nine years later by creation of an aortopulmonary connection. The patient's functional status was New York Heart Association class I despite evident central cyanosis. A CD was performed under general anesthesia. Fentanyl, etomidate, and succinylcholine were utilized for induction, and intrathecal morphine was administered for postoperative pain control. The baseline CO (7.2 LÁmin -1 ), blood pressure (156/74 mmHg), heart rate (74 beatsÁmin -1 ), and total peripheral resistance (1,059 dynesÁsec -1 Ácm -5 ) remained stable throughout the procedure. Maintenance anesthesia consisted of rocuronium, sevoflurane, and an oxygen/nitrous oxide mixture. Upon delivery, an infusion of oxytocin combined with ergometrine was administered. Hemodynamic parameters remained stable and no vasopressor was required. Conclusion Balanced general anesthesia and careful titration of uterotonic agents provided stable hemodynamic conditions during CD in a patient with a palliated TOF, as assessed by a continuous noninvasive CO monitor. Noninvasive CO monitoring may improve our understanding of the hemodynamic implications of various anesthetic techniques for CD in cardiac patients. RésuméObjectif La te´tralogie de Fallot (TF) est l'une des causes les plus fre´quentes de cardiopathie conge´nitale cyanosante. La prise en charge anesthe´sique des parturientes ayant une TF non corrige´e est controverse´e et rele`ve du de´fi, en particulier en cas d'accouchement par ce´sarienne. Nous de´crivons l'utilisation d'un monitorage non invasif du de´bit cardiaque (DC) pour aider la prise en charge de la ce´sarienne chez une femme ayant une TF ope´re´e sous anesthe´sie ge´ne´rale. Caractéristiques cliniques Une femme aˆge´e de 34 ans se pre´sente pour une ce´sarienne programme´e à 38 semaines de grossesse. Elle est ne´e avec une TF et a subi une intervention modifie´e de Blalock-Taussig a`l'aˆge de six ans, puis neuf ans plus tard la cre´ation d'une connexion aorto-pulmonaire. Le statut fonctionnel de la patiente

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“…History of ablation and cardiothoracic ratio on chest radiography are predictors of adverse events. 53 Pregnant women with tetralogy of Fallot have an increased risk of fetal loss and congenital abnormalities so that fetal imaging should be performed. 54 Follow-up depends on clinical status and on the presence of severe pulmonary regurgitation.…”

Section: Tetralogy Of Fallotmentioning

confidence: 99%

Pregnancy and heart disease: what Internists should know

Gerloni

Panuccio²

2017

Ital J Med

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Cardiac disease can rarely complicate pregnancy (e.g., only 1 to 4% of pregnancies in the United States), but it still remains a major cause of non-obstetric maternal morbidity and mortality. 1 During pregnancy, a woman can suffer from heart failure because of a pre-existing heart disease or a new onset cardiopathy pregnancy correlated. Approximately 2% of pregnancies involve cardiac disease, and in the current era, most maternal disease is due to congenital heart disease (CHD).2 Currently cardiac surgery improvement of the last 50 years has permitted an increased number of survivors. Instead, in the past, rheumatic heart disease was the leading cause of heart failure in pregnancy.3,4 Further, with increasing maternal age, other etiologies of heart disease should not be ignored and, particularly, ischemic and hypertensive heart disease should be considered in an over forty pregnant women. 5 Physiology of normal pregnancyImportant hemodynamic changes appear during pregnancy and are responsible for heart failure in pregnant women with pre-existing heart disease. These changes begin early in pregnancy, generally during the first eight weeks, reach their peak during the late second trimester, and then remain relatively constant until delivery. 6 The plasma volume and red cell mass are the first major cardiocirculatory modification, actually they expand in the 8 th week and peak around 30 th week, with a net plasma volume gain of 1000-1600 mL, corresponding to 30-50% above baseline.7 A greater increase in intravascular volume compared to red cell mass results in the dilutional anemia of pregnancy. This aspect generally results at 30-34 weeks when plasma volume peaks in relation to red cell mass and is associated with sodium and water retention. Actually 1000 mEq of sodium and 6 liters of water are retained and distributed among amniotic fluid, fetus and intra and extracellular spaces.8 Further cardiac output increases to satisfy increase fetal and maternal metabolic needs. It can be estimated 30-50% above baseline levels during the entire pregnancy, but half of this change occurs by 8 th week. This relevant change is a consequence of blood volume augmentation, afterload reduction and maternal heart rate rise.9 Systemic Pregnancy and heart disease: what Internists should know ABSTRACTPregnant women with heart disease are increasing due to medical and surgical progress and, nowadays, congenital heart disease is the most frequent heart disease affecting these women. Pregnancy represents a considerable effort for an altered heart with negative consequences for life quality, disease progression and mortality. Risk differs a lot among patients and depends not only on the type of heart disease. Clinician should stratify risk and offer patients a correct pre-counselling and accurate follow-up. At the same time Clinician should be able to diagnose rapidly heart failure as some cardiopathies, such as peripartum cardiomyopathy, are related to pregnancy and produce symptoms that can be confused with normal pregnancy progression...

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Outcomes of pregnancy in women with tetralogy of fallot

Cited by 211 publications

References 16 publications

Peripartum cardiomyopathy in uncorrected tetralogy of fallot: a case report

Peripartum cardiomyopathy in uncorrected tetralogy of fallot: a case report

Cardiac output monitoring during Cesarean delivery in a patient with palliated tetralogy of Fallot

Pregnancy and heart disease: what Internists should know

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