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

Abstract

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.

Complex Congenital Heart Disease in the Adult

“…Patients with a systemic right ventricle in the setting of L-TGA experience similar adverse outcomes and also should be advised against pregnancy in the setting of severe systemic ventricular dysfunction or atrioventricular valve regurgitation. Patients palliated with the arterial switch operation for the management of D-TGA typically tolerate pregnancy well, and fetal outcomes are comparable to that of the general obstetrical population (69).…”

“…Patients who have undergone the atrial switch operation for the management of D-TGA and have systemic ventricular dysfunction are at significantly increased risk for pregnancy-related mortality and severe morbidity compared to the general obstetrical population (69). The most common cardiac complications include arrhythmias, which can potentially be life threatening, heart failure, and worsening functional class.…”

High-Risk Congenital Heart Disease in Pregnancy

“…In addition, there is a high incidence of premature births and fetal loss. 27 As in other cases, Cesarean section is reserved for patients with acute heart failure at the time of delivery.…”