Pregnancy Outcomes in Women With Transposition of the Great Arteries After an Arterial Switch Operation

Stoll, Victoria; Drury, Nigel E; Thorne, Sara; Selman, Tara; Clift, Paul; Chong, Hsu Phern; Thompson, Peter J.; Morris, R.; Hudsmith, Lucy

doi:10.1001/jamacardio.2018.2747

Cited by 16 publications

(10 citation statements)

References 16 publications

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“…Four studies described the outcome in patients during pregnancy [ 50 , 51 , 52 , 53 ] ( Table 5 ). 45 patients were followed peri- and post-partum during 73 pregnancies.…”

Section: Resultsmentioning

confidence: 99%

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The Coronary Arteries in Adults after the Arterial Switch Operation: A Systematic Review

Engele

Mulder

Schoones

et al. 2021

JCDD

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Coronary artery status in adults long after the arterial switch operation (ASO) is unclear. We conducted a systematic review to provide an overview of coronary complications during adulthood and to evaluate the value of routine coronary imaging in adults after ASO, in light of current guidelines. Articles were screened for the inclusion of adult ASO patients and data on coronary complications and findings of coronary imaging were collected. A total of 993 adults were followed with a median available follow-up of only 2.0 years after reaching adulthood. Myocardial ischemia was suspected in 17/192 patients (8.9%). The number of coronary interventions was four (0.4%), and coronary death was reported in four (0.4%) patients. A lack of ischemia-related symptoms cannot be excluded because innervation studies indicated deficient cardiac innervation after ASO, although data is limited. Anatomical high-risk features found by routine coronary computed tomography (cCT) included stenosis (4%), acute angle (40%), kinking (24%) and inter-arterial course (11%). No coronary complications were reported during pregnancy (n = 45), although, remarkably, four (9%) patients developed heart failure. The 2020 European Society of Cardiology (ESC) guidelines state that routine screening for coronary pathologies is questionable. Based on current findings and in line with the 2018 American ACC/AHA guidelines a baseline assessment of the coronary arteries in all ASO adults seems justifiable. Thereafter, an individualized coronary follow-up strategy is advisable at least until significant duration of follow-up is available.

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“…Four studies described the outcome in patients during pregnancy [ 50 , 51 , 52 , 53 ] ( Table 5 ). 45 patients were followed peri- and post-partum during 73 pregnancies.…”

Section: Resultsmentioning

confidence: 99%

“…These outcomes were not associated with coronary events but could partly be attributed to valvular heart disease. Risk factor for adverse outcome included older age at ASO and higher maternal age [ 50 , 51 , 52 , 53 ].…”

Section: Resultsmentioning

confidence: 99%

The Coronary Arteries in Adults after the Arterial Switch Operation: A Systematic Review

Engele

Mulder

Schoones

et al. 2021

JCDD

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“…Although ATSO has been gradually replaced by ASO in children with D‐TGA, there are women with history of Mustard or Senning procedure in the childbearing age who plan to have children. 7 , 22 , 27 , 28 , 29 The modified World Health Organization classification for prediction of pregnancy risk includes D‐TGA as a class III and predicts significant risk of maternal mortality or severe morbidity. 30 This classification often affects major decisions, including advising against conception, early termination of pregnancy, interventions during pregnancy, as well as early CS delivery.…”

Section: Discussionmentioning

confidence: 99%

Outcome of Pregnancy in Women With D‐Transposition of the Great Arteries: A Systematic Review

Pizula

Devera

et al. 2022

JAHA

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Background Information on maternal and fetal outcomes of pregnancy in women with D‐transposition of the great arteries is limited. We conducted a systematic literature review on pregnancies in women with transposition of the great arteries after atrial and arterial switch operations to better define maternal and fetal risk. Methods and Results A systematic review was performed on studies between 2000 and 2021 that identified 676 pregnancies in 444 women with transposition of the great arteries. A total of 556 pregnancies in women with atrial switch operation were tolerated by most cases with low mortality (0.6%). Most common maternal complications, however, were arrhythmias (9%) and heart failure (8%) associated with serious morbidity in some patients. Worsening functional capacity, right ventricular function, and tricuspid regurgitation occurred in ≈20% of the cases. Rate of fetal and neonatal mortality was 1.4% and 0.8%, respectively, and rate of prematurity was 32%. A total of 120 pregnancies in women with arterial switch operation were associated with no maternal mortality, numerically lower rates of arrhythmias and heart failure (6% and 5%, respectively), significantly lower rate of prematurity (11%; P <0.001), and only 1 fetal loss. Conclusions Pregnancy is tolerated by most women with transposition of the great arteries and atrial switch operation with low mortality but important morbidity. Most common maternal complications were arrhythmias, heart failure, worsening of right ventricular function, and tricuspid regurgitation. There was also a high incidence of prematurity and increased rate of fetal loss and neonatal mortality. Outcome of pregnancy in women after arterial switch operations is more favorable, with reduced incidence of maternal complications and fetal outcomes similar to women without underlying cardiac disease.

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“…However, unemployment was almost twice the rate, compared to the normal German population and even higher than in a cross-sectional survey from the National Registry for Congenital Heart Defects in Germany [ 25 ]. Living in partnership was in the normal range compared to the German population, but the offspring rate was found low for both genders, in which pregnancy has been basically well tolerated with good maternal outcomes after ASO for TGA [ 26 ].…”

Section: Discussionmentioning

confidence: 99%

Socio-demographic parameters and non-cardiac comorbidity related to self-perceived quality of life in young adults after neonatal arterial switch operation for transposition of the great arteries

et al. 2022

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Evaluating the relation of non-cardiac comorbidity and socio-demographic factors to physical and mental health-related quality of life (QOL) which has been partially found at elevated risk in young adults after neonatal arterial switch operation (ASO) for transposition of the great arteries (TGA). In a prospective reassessment study, results of 92 unselected young adults (22.8 ± 2.6 years) having undergone evaluation of QOL (SF-36) were related to non-cardiac comorbidity with special respect to neurologic and psychiatric comorbidity and to socio-demographic parameters. Neurologic (14%) contrary to psychiatric comorbidities (6.5%) were more frequent than in the general population. The educational level was higher, the rate of unemployment was double as high compared to the average German population. Significant inverse relations (p = 0.006 to 0.033) existed between physical health domains (physical functioning and general health perception) and non-cardiac, neurologic, and psychiatric comorbidity, as well as correlations between the latter domains and socio-economic status, educational level, and worse employment status (Spearman 0.22–0.41, p < 0.0001 to 0.036). Mental health domains (vitality, social functioning, psychical health) were significantly inversely related with neurologic and psychiatric comorbidity (p = 0.002 to 0.048) and correlated with higher educational level (Spearman 0.25, p = 0.019). Neurologic and psychiatric comorbidities and socio-demographic parameters are significant risk factors for a reduced QOL concerning physical and mental health in young adults with TGA after ASO. Standardized QOL measurement should be part of routine screening programs to detect subclinical physical, neurodevelopmental, and psychosocial comorbidity. Graphical abstract

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Pregnancy Outcomes in Women With Transposition of the Great Arteries After an Arterial Switch Operation

Cited by 16 publications

References 16 publications

The Coronary Arteries in Adults after the Arterial Switch Operation: A Systematic Review

The Coronary Arteries in Adults after the Arterial Switch Operation: A Systematic Review

Outcome of Pregnancy in Women With D‐Transposition of the Great Arteries: A Systematic Review

Socio-demographic parameters and non-cardiac comorbidity related to self-perceived quality of life in young adults after neonatal arterial switch operation for transposition of the great arteries

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