Pregnancy outcome in women with repaired versus unrepaired isolated ventricular septal defect

Abstract

Objective To compare the risks of pregnancy complications in women with repaired and unrepaired isolated ventricular septal defect (VSD).Design A retrospective multicentre study.Setting Tertiary centres in the Netherlands and Belgium.Methods Women were identified using two congenital heart disease registries. Eighty-eight women were identified who had experienced 202 pregnancies, including 46 miscarriages and nine terminations of pregnancy. Information on each completed pregnancy (n = 147; unrepaired VSD, n = 104; repaired VSD, n = 43) was obtained using medical records and telephone interviews. Data from the Generation R database (prospective cohort study; n = 9667) were used to determine the background risk (controls). Odds ratios and 95% CI were estimated using general estimation equation analysis adjusted for multiple pregnancies per woman, maternal age and parity status.Main outcome measures Adjusted odds ratios (AORs) for developing pregnancy complications in relation to corrective status.Results Pregnancies in women with an unrepaired VSD were associated with a higher risk of pre-eclampsia (AOR 4.59, 95% CI 2.01-10.5, P < 0.001) compared with controls. No differences were observed when comparing women with repaired VSD and controls. Pregnancies in women with repaired VSD were associated with a higher risk of premature labour (AOR 4.02, 95% CI 1.12-14.4, P = 0.03) and small-for-gestational-age (SGA) births (AOR 4.09, 95% CI 1.27-13.2, P = 0.02) compared with women with unrepaired VSD.Conclusions Women with unrepaired VSD are at increased risk of pre-eclampsia, which suggests that it is not a benign condition. In addition, women with repaired VSD are at increased risk of premature labour and SGA births compared with women with unrepaired VSD.

Heart failure in pregnant women with cardiac disease: data from the ROPAC

“…This may be partially explained by the high percentage of pulmonary hypertension in some of the lesions, such as mitral stenosis and/or regurgitation and uncorrected shunt lesions. Yap et al 26 27 described a higher rate of complications in patients with uncorrected shunts, in patients with atrial septal defects and ventricular septal defect, but none of the women developed HF. We reported a HF rate of 3.8% in patients with atrial switch procedure for transposition of the great arteries which is relatively low compared to previously reported rates of 2.7%, 4.1% and 7.1% 28–30…”

Pregnancy and Adult Congenital Heart Disease

“…Women with repaired VSD are at increased risk of premature labor and intrauterine growth retardation as well. 12 A PDA, if small, will be silent or present as a soft continuous infraclavicular, left sternal border or left upper back murmur, which enhances with isometrics, while a moderate PDA may demonstrate ventricular enlargement and a displaced point of maximal impulse on palpation.…”

Echocardiography in Pregnancy: Part 1

“…On Doppler, a high velocity jet is seen from LV to RV with normal chamber dimensions and function [12]. These defects are well tolerated during pregnancy [4,13]. However, in the presence of a large defect, left ventricular volume overload and RV hypertrophy occur.…”