A functional understanding of moderate to complex congenital heart disease and the impact of pregnancy. Part I: The transposition complexes

A functional understanding of moderate to complex congenital heart disease and the impact of pregnancy. Part II: Tetralogy of Fallot, Eisenmenger’s syndrome and the Fontan operation

“…It is described using the system outlined in Part 1. 39 (i) There is a large atrial septal defect (feature 2), which allows free mixing of oxygenated blood from the lungs and deoxygenated blood from the vena cava. (ii) There is tricuspid atresia, (feature 4), which means there is no direct connection between the right atrium and the right ventricle.…”

Management of labour and delivery in congenitally corrected transposition of great arteries

“…5 Management of women with transposition complexes during pregnancy, labour and delivery is well described. 6 Significant physiological changes occur during pregnancy, some of which may adversely affect the haemodynamic status of a woman with uncorrected significant heart disease such as CC-TGA. These changes include a rise in cardiac output (25-50% above baseline), increase in stroke volume (SV), heart rate and circulatory catecholamines, and a decrease in peripheral vascular resistance.…”

Congenital Heart Disease in the Adult

“…Systemic vascular resistance (SVR) decreases, and aortocaval compression by the gravid uterus can lead to reduced venous return, cardiac output, and uterine blood flow. 22,23 These physiologic changes can precipitate arrhythmias, heart failure, and cardiovascular events that require urgent invasive intervention. 21,24 Risks to the fetus include poor maternal functional status before pregnancy or maternal cyanosis, left heart obstruction (see below), maternal age below 20 and above 35 years, maternal smoking, and treatment with anticoagulants.…”

“…21,24 Maternal and fetal morbidity and mortality can be estimated for some CHD lesions and are summarized in reports from the United States and Europe. [21][22][23][24][25] '…”