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

Successful epidural anesthesia for cesarean delivery in a woman with Fontan repair

“…Although longevity has been improved, event-free survival is significantly lower at 96%, 87%, and 64% at 1, 5, and 10 years, respectively [7]. Classic Fontan physiology separates pulmonary and systemic circulations, allowing the single functional ventricle to maintain systemic flow, whereas pulmonary blood flow becomes entirely passive [8]. Our patient had a right ventricle, although with the Ebstein anomaly and hypoplasia, the contribution to pulmonary flow was minimal; and her physiology was described as classic Fontan.…”

Case report of a parturient with cyanotic congenital heart disease palliated with a Glenn procedure

“…While a successful live birth is possible in patients palliated with the Fontan procedure, there is a high incidence of maternal infertility [5]. In those patients with Fontan physiology who do become pregnant, pregnancy is commonly complicated by premature preterm rupture of membranes, premature labor, spontaneous abortion, and neonatal death.…”

Cardiovascular Management in Pregnancy

“…Death occurs most commonly in the third trimester or first few weeks after successful delivery, so that continued monitoring in the postpartum period is required. 98 Fetal loss is also significantly increased with spontaneous abortion occurring in up to 40% to 50%. 5,95 Termination of pregnancy is often recommended early in the pregnancy and should be undertaken in a facility with expertise in the management of both CHD and pulmonary hypertension.…”