Pregnancy after surgical correction of tetralogy of Fallot.

Abstract

not differ significantly between those patients who had taken nonsteroidal anti-inflammatory drugs (20 out of 22; 91 %) and those who had not (33 out of 48; 69%). The relative frequency of consumption of individual non-steroidal anti-inflammatory drugs did not differ between the patients with stricture and the controls (table), and ibuprofen, indomethacin, and aspirin were the drugs most often used by both groups. DiscussionWe found an association between prior consumption of non-steroidal anti-inflammatory drugs and the development of benign oesophageal stricture. Before dysphagia occurred most of our patients had had symptoms of gastro-oesophageal reflux, and almost all had evidence of reflux at the time the stricture was diagnosed. This suggests that such drugs may aggravate reflux oesophagitis and so increase the risk of formation of stricture.Swallowed tablets may remain in the oesophagus for considerable periods; Evans Prostaglandins are believed to have a cytoprotective action on the gastric mucosa,6 and non-steroidal anti-inflammatory drugs may exert their ulcerogenic effect by reducing generation of mucosal prostaglandins. A similar action in the oesophagus might contribute to mucosal damage and aggravate reflux oesophagitis. The proportion of patients suffering from rheumatoid disease did not differ significantly between the patients with peptic stricture and the controls, which suggests that rheumatoid disease in itself does not predispose to the formation of stricture.These findings indicate that non-steroidal anti-inflammatory drugs should be prescribed with caution in the presence of symptomatic gastro-oesophageal reflux; if they are used endoscopic monitoring for oesophageal damage would seem advisable. Introduction "Total" or radical surgical correction of tetralogy of Fallot has become standard practice, and of those patients surviving radical surgery about 95% are alive five to 10 years later.'-3 About half the deaths occurring after the perioperative period are in the first postoperative year and are caused by heart failure resulting from residual abnormalities. These include ventricular septal defects, pulmonary hypertension, and abnormalities of conduction or rhythm. Survivors of surgery show an improvement in effort tolerance and loss of cyanosis.2 4 Uncorrected cyanotic heart disease carries a high risk in pregnancy for both mother and fetus: a review of 57 pregnancies in women with uncorrected tetralogy of Fallot showed a fetal mortality of 22% and a maternal mortality of 7%.5 The high fetal mortality was caused by poor fetal growth, leading to a high incidence of abortion, prematurity, and small-for-dates babies. Pregnancy in patients with surgically corrected tetralogy of Fallot is increasing, but no large, detailed series of such pregnancies has been reported. References

Pregnancy in Patients with Tetralogy of Fallot

“…2,7,11 Surgical repair of TOF has a low perioperative mortality, and survivors are much improved symptomatically and are able to cope adequately with demands of pregnancy. 8 In a review of 58 pregnancies in 41 women with repaired TOF, Singh et al 8 reported that pregnancy outcome for both mother and fetus is greatly improved with surgical correction prior to pregnancy: these authors reported a live birth rate of 78% versus 33%, maternal mortality 0% versus 4% to 12%, and rate of congestive cardiac failure 2% versus 40%. In a study of 9 pregnancies in patients with TOF reported by Shime et al, 4 7 had undergone prior corrective surgery.…”

“…3 The potential predictors of maternal morbidity include functional class, ventricular dysfunction, significant arrhythmias, cyanosis, severe outflow tract obstruction, pulmonary hypertension, and need for anticoagulation. 3,7 Pregnancy in corrected TOF is comparable to that in the general population, 8,9 but each patient needs to be individually assessed for the ability to tolerate hemodynamic changes during pregnancy. Corrective cardiac surgery improves both maternal and perinatal outcome by improving hemodynamic parameters, improving placental perfusion, and reducing the likelihood of cardiac complications.…”

Retrospective analysis of outcome of pregnancy in women with congenital heart disease: Single‐centre experience from North India

“…Singh et al . reviewed 40 pregnancies in 27 women with surgically corrected TOF and reported good maternal and perinatal outcome 13 …”

Outcomes of pregnancy in women with tetralogy of fallot

“…Previously published series have demonstrated little or no risk to the mother with a repaired TOF. Singh et al (9) reported 40 successful pregnancies in 27 women, with no adverse maternal cardiovascular events. Similarly, Nissenkorn et al (12) demonstrated no maternal complications in five women who had nine pregnancies, and the authors stressed the importance of alleviating a significant residual hemodynamic burden before pregnancy.…”