Congenital Heart Disease: Its Impact on Pregnancy

Whittemore, Ruth

doi:10.1080/21548331.1983.11702706

Cited by 24 publications

(7 citation statements)

References 9 publications

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“…Previous studies showed that cyanosis, poor maternal functional class, and left heart obstruction were associated with neonatal complications in pregnant women with cardiac disease [6,9,20]. Maternal oxygen saturation has been inversely associated with low birth weight and fetal mortality [26,27]. In the present study, the only woman presenting with cyanosis delivered at term a neonate with small for gestational age birth weight.…”

Section: Discussionmentioning

confidence: 60%

Prediction of complications in pregnant women with cardiac diseases referred to a tertiary center

Jastrow

Meyer

Khairy

et al. 2011

International Journal of Cardiology

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Section: Discussionmentioning

confidence: 60%

Prediction of complications in pregnant women with cardiac diseases referred to a tertiary center

Jastrow

Meyer

Khairy

et al. 2011

International Journal of Cardiology

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“…The relationship between maternal cyanosis and fetal growth has been well defined; maternal oxygen saturation is inversely related to birth weight and fetal mortality. 6,21 The effect of functional class and left heart obstruction on preterm delivery, fetal death, and growth retardation is likely mediated by uteroplacental insufficiency. Indeed, fetal cardiac contractility and output are adversely affected by hypoxic academia resulting from uteroplacental insufficiency.…”

Section: Discussionmentioning

confidence: 99%

Adverse Neonatal and Cardiac Outcomes Are More Common in Pregnant Women With Cardiac Disease

et al. 2002

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Background-Pregnant women with heart disease (HD) are at increased risk for cardiac (CV) complications. However, the frequency of neonatal (NE) complications in pregnant women with HD relative to pregnant women without HD has not been examined. Methods and Results-Pregnant women with HD were prospectively monitored during 302 pregnancies. The frequency of NE and CV complications was compared with those in a control group without HD during 572 pregnancies. The frequency of NE complications was higher in the HD group (18% versus 7%; HD versus controls). The NE complication rate was lowest in pregnancies of women age 20 to 35 years who did not smoke during pregnancy, did not receive anticoagulants, and had no obstetric risk factors: 4% in control patients, 5% in HD patients with no cardiac risk factors for NE complications (left heart obstruction, poor functional class, or cyanosis), and 7% in HD patients with Ն1 such risk factor. In contrast, the event rate in pregnancies of controls age Ͻ20 or Ͼ35 years who had obstetric risk factors or multiple gestation or who smoked was 11%. In the HD group, women age Ͻ20 or Ͼ35 years who had obstetric risk factors or multiple gestation, who smoked, or who received anticoagulants experienced an even higher NE complication rate (27% with no cardiac risks for NE events and 33% in the presence of Ն1 cardiac risk factors). The frequency of CV complications was higher in the HD group (17% versus 0%; HD versus controls). Conclusion-Pregnant women with HD are at increased risk for both NE and CV complications. The risk for NE adverse events in pregnant women with HD is highest in those with both obstetric and cardiac risk factors for NE complications.

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“…The goals of anaesthesia are to avoid an increase in pulmonary vascular resistance, a decrease in venous return and the cardiodepressant effect of anaesthetic drugs [10]. There has been no reported maternal death or serious morbidity in the mother with the Fontan circulation attributed to anaesthesia [11, 12]. In our case the patient retained a good functional level throughout both pregnancies and deliveries.…”

Section: Discussionmentioning

confidence: 67%

Caesarean section following the Fontan procedure: two different deliveries and different anaesthetic choices in the same patient

Eid

Ginosar

Elchalal³

et al. 2005

Anaesthesia

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SummaryThe Fontan procedure is performed for patients with a hypoplastic right ventricle, and pregnancies following this palliative surgery are likely to increase. We present a parturient with the Fontan physiology who successfully underwent two consecutive caesarean deliveries; the first under general anaesthesia for emergency surgery and the second under regional anaesthesia for elective surgery. We suggest that pregnancy and delivery do not typically adversely affect maternal cardiac status in these patients. Attention must be paid, however, to fetal loss, prematurity, growth retardation and associated cardiac congenital malformations for which insufficient data exist in the literature in this patient population. The 2000-2002 Report of the Confidential Enquiries into Maternal Deaths [1] highlighted cardiac disease as the second most frequent cause of maternal death, and 20% of these were cases of congenital cardiac disease. We present a parturient with the Fontan physiology who successfully completed two consecutive pregnancies and deliveries. Previous individual case reports of pregnancy following the Fontan procedure discuss anaesthetic guidelines [2,3] or focus on potential complications during labour and delivery [3,4]. To date, only one study has included a large series, of 33 Fontan deliveries, with regard to maternal and fetal outcome [5]. The novelty of our case resides not only in two successive pregnancies 1 year apart for the same woman, but also in two different anaesthetic approaches for two different obstetric situations. We describe the Fontan procedure and its anaesthetic implications along with a presentation of our conclusions regarding management of such cases. Case reportA 25-year-old nulliparous patient presented initially at 12 weeks of gestation in her first pregnancy. She was born with a hypoplastic right ventricle and tricuspid atresia, for which she underwent a Blalock-Taussig shunt at 12 years, a Glenn shunt at 19 years and a superseding Fontan procedure at 22 years. The procedure involved transposition of the pulmonary trunk to the right atrium using a tunnel technique with a Gore-Tex tube graft. Following the Fontan procedure she was well with a normal level of activity (New York Heart Association class I).At initial presentation she had no history of dyspnoea, orthopnoea or arrhythmias. She had clubbing, but no cyanosis. There was no peripheral oedema. Blood pressure was 120 ⁄ 85 mmHg and heart rate regular at 82 beats.min )1 . A loud systolic ejection, pansystolic murmur could be heard over the precordium. Lung fields were clear and arterial oxygen saturation was 95% in room air. Echocardiography demonstrated good superior and inferior vena caval flow to the pulmonary artery, good ventricular function, but moderate to severe mitral regurgitation and severe tricuspid regurgitation. Her body weight was 54 kg. At 24 weeks' gestation she was hospitalised with an abnormal fetal ultrasound showing absent end-diastolic

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Congenital Heart Disease: Its Impact on Pregnancy

Cited by 24 publications

References 9 publications

Prediction of complications in pregnant women with cardiac diseases referred to a tertiary center

Prediction of complications in pregnant women with cardiac diseases referred to a tertiary center

Adverse Neonatal and Cardiac Outcomes Are More Common in Pregnant Women With Cardiac Disease

Caesarean section following the Fontan procedure: two different deliveries and different anaesthetic choices in the same patient

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