Pregnancy outcome in women with congenital heart disease and residual haemodynamic lesions of the right ventricular outflow tract

Greutmann, Matthias; Klemperer, Kate von; Brooks, R. J.; Peebles, Donald; O’Brien, Patrick; Walker, Fiona

doi:10.1093/eurheartj/ehq157

Cited by 64 publications

(44 citation statements)

References 12 publications

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“…[5][6][7]78,114,157,[160][161][162][163][164][165] Women with repaired right ventricular (RV) outflow tract obstruction (eg, tetralogy of Fallot or pulmonary atresia) are at risk of developing right-sided heart failure. 78,166,167 Pregnancy is contraindicated in women with severe systemic ventricular dysfunction (left ventricular ejection fraction <30%, NYHA class III or IV).…”

Section: Heart Failurementioning

confidence: 99%

Management of Pregnancy in Patients With Complex Congenital Heart Disease: A Scientific Statement for Healthcare Professionals From the American Heart Association

Canobbio¹,

Warnes²,

Aboulhosn³

et al. 2017

Circulation

351

303

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Today, most female children born with congenital heart disease will reach childbearing age. For many women with complex congenital heart disease, carrying a pregnancy carries a moderate to high risk for both the mother and her fetus. Many such women, however, do not have access to adult congenital heart disease tertiary centers with experienced reproductive programs. Therefore, it is important that all practitioners who will be managing these women have current information not only on preconception counseling and diagnostic evaluation to determine maternal and fetal risk but also on how to manage them once they are pregnant and when to refer them to a regional center with expertise in pregnancy management.

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Section: Heart Failurementioning

confidence: 99%

Management of Pregnancy in Patients With Complex Congenital Heart Disease: A Scientific Statement for Healthcare Professionals From the American Heart Association

Canobbio¹,

Warnes²,

Aboulhosn³

et al. 2017

Circulation

351

303

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“…5 There are reports of pulmonary valve replacement 6 or percutaneous valve implantation within a right-sided conduit to facilitate pregnancy in such patients. 7 Not all pregnancies are planned, and it is likely that there will be an increasing number of unplanned pregnancies in women with RV to pulmonary artery conduits whose cardiac status may not be well suited to pregnancy.…”

Section: Discussionmentioning

confidence: 99%

Percutaneous Pulmonary Valve Replacement During Pregnancy

et al. 2014

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e373T he number of women of childbearing age who have congenital heart disease is increasing.1 A similar proportion of these women can be expected to attempt pregnancy as women in general.2 Although most of these women can be expected to tolerate pregnancy well, particularly if the pregnancy is carefully planned following appropriate clinical evaluation, not all pregnancies are planned, and some will occur in women with unsuitable hemodynamics.We report the case of a 21-year-old woman born with pulmonary atresia and a ventricular septal defect (VSD), ultimately palliated by a fenestrated closure of VSD and a valved homograft conduit placement between the right ventricle and the main pulmonary artery at the age of 3 years, who presented at 16 weeks gestation with a severely degenerate conduit. Case ReportA 21-year-old woman had been born with pulmonary atresia and a VSD. She was initially palliated with bilateral Blalock-Taussig shunts (classical left and modified right) in the neonatal period because her pulmonary artery confluence was hypoplastic. At 3 years of age, she underwent reparative surgery consisting of closure of the VSD with a fenestrated patch and the placement of a 19-mm homograft valved conduit between the right ventricular outflow tract (RVOT) and the pulmonary artery bifurcation, thereby stimulating growth of the hypoplastic pulmonary artery confluence. The bilateral Blalock-Taussig shunts were ligated. At the age of 18 years, both of her pulmonary arteries were stented because of distorted and stenotic branch pulmonary arteries. The fenestration of the VSD patch was closed interventionally by the use of a muscular VSD closure device. At 20 years of age, there was clinical and echocardiographic evidence of degeneration of the homograft conduit, and she was advised against pregnancy pending further evaluation.Approximately 6 months later, she presented at 16 weeks gestation of an unplanned pregnancy. At this stage, she was asymptomatic and clinically well. At 20 weeks, she remained asymptomatic but was showing clinical evidence of hemodynamic decompensation with raised jugular venous pressure and echocardiographic evidence of worsening right ventricular (RV) dilation with high RV pressure. There was severe pulmonary regurgitation and significant RVOT obstruction with Doppler evidence of RV hypertension. Obtaining a good-quality Doppler signal across the RVOT was difficult but was at least 3 m/s. There was evidence of fetal growth retardation from an obstetric/fetal well-being assessment. At 23 weeks, the otherwise healthy female fetus had an estimated weight of 480 g (expected mean weight at 24 weeks is 600 g).The clinical view was that the patient was at risk of sudden hemodynamic decompensation or life-threatening arrhythmia. There was concern that the pregnancy might not be sustained long enough for the fetus to reach a viable maturity.The management options available were to let the pregnancy continue, deliver the baby at the earliest possible gestation, surgically replace the conduit, or imp...

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“…However, Greutman, et al, found that most outcomes of pregnancies in patients with CHD and residual right ventricular outflow tract lesions were good. (26) Although the incidence of cardiac disease in pregnancy is reported to be stable, the clinical problems caused by these lesions are increasing. (27) The increasing numbers seen at the clinic in this study probably reflect better recruitment of appropriate cases (Figure 1).…”

Section: Management Of Cardiac Disease In Pregnancymentioning

confidence: 99%

Patient profi le of a tertiary obstetric-cardiac clinic

Merwe

Hall

Herbst

et al. 2017

SAHJ

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relatively fixed combination of factors, can often surprise one. Gestational age at presentation, the unique combination of maternal functional status at a given gestation coupled with the severity of cardiac disease and the known natural course Results: There were 231 women, rheumatic heart disease (n=79; 34.2%) was the predominant cardiac disease followed by congenital heart disease (n=78; 33.8%), medical conditions (n=38; 16.4%) and previous peripartum cardiomyopathy (n=9; 3.9%). Eighty-two women (35.5%) were perceived to be extremely high risk and their entire pregnancies were managed in the Obstetric-Cardiac clinic. The most common RHD lesion was mitral regurgitation (34.2%) and mixed mitral valve disease (24.1%). The most frequent CHD was ventricular septal defects (n=27; 35%). Conclusions: The cardiac disease profi le of patients seen at this obstetric-cardiac clinic in a South African tertiary hospital refl ects a transition from the disease profi le of a typical developing country (high burden of rheumatic heart disease) to the disease profi le seen in a more developed country (high burden of congenital heart disease). This could indicate improved quality of socio-economic development and the health care system. The increasing complexity of cardiac pathology that has to be dealt with in pregnant patients presenting to a tertiary hospital requires close collaboration between the obstetrician, cardiologist, cardiac surgeon and anesthetist caring for these patients. A dedicated obstetric-cardiac clinic is a good model to utilise in a tertiary hospital when aiming to optimise the care of patients with cardiac disease in pregnancy.

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Pregnancy outcome in women with congenital heart disease and residual haemodynamic lesions of the right ventricular outflow tract

Cited by 64 publications

References 12 publications

Management of Pregnancy in Patients With Complex Congenital Heart Disease: A Scientific Statement for Healthcare Professionals From the American Heart Association

Management of Pregnancy in Patients With Complex Congenital Heart Disease: A Scientific Statement for Healthcare Professionals From the American Heart Association

Percutaneous Pulmonary Valve Replacement During Pregnancy

Patient profi le of a tertiary obstetric-cardiac clinic

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