Success in a Fontan pregnancy: how important is ventricular function?

Ordóñez, María Victoria; Trinder, Johanna; Curtis, Stephanie

doi:10.1017/s1047951118001865

Cited by 4 publications

(7 citation statements)

References 10 publications

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“…The earliest is a miscarriage, which happened in the analyzed population in 11 (42%) pregnancies, all but one in the first trimester. These observations were the same as described by Bonner et al [14] and were similar to the incidence of 27-69% published in previous reports [1,5,7,13,15,16]. These numbers are much higher than the spontaneous miscarriage rates of 10-15% observed in the general European population [17].…”

Section: Discussionsupporting

confidence: 91%

“…Our analysis confirmed that pregnancy in Fontan survivors is possible and may also be successful [1,5,7,13]. However, a woman considering pregnancy must be aware of potential risks and complications for herself and the baby.…”

Section: Discussionsupporting

confidence: 73%

“…These numbers are much higher than the spontaneous miscarriage rates of 10-15% observed in the general European population [17]. The reason for this fatal condition is not completely clear, but it may result from abdominal venous congestion, increased venous pressure, and inability to increase cardiac output [1,5,6,18].…”

Section: Discussionmentioning

confidence: 99%

“…Additionally, there is a rise in prothrombotic factors during pregnancy. All these changes challenge the distorted univentricular heart after the Fontan procedure [5]. Moreover, high systemic venous pressures and limited reserve to increase cardiac output may impact placental perfusion [6].…”

Section: Introductionmentioning

confidence: 99%

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Pregnancy Outcomes in Women after the Fontan Procedure

Bartczak-Rutkowska

Tomkiewicz‐Pająk

Kawka-Paciorkowska

et al. 2023

JCM

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Women with single ventricle physiology after the Fontan procedure, despite numerous possible complications, can reach adulthood and give birth. Pregnancy poses a hemodynamic burden for distorted physiology of Fontan circulation, but according to the literature, it is usually well tolerated unless the patient is a “failing” Fontan. Our study aimed to assess maternal and fetal outcomes in patients after the Fontan procedure followed up in two tertiary Polish medical centers. We retrospectively evaluated all pregnancies in women after the Fontan procedure who were followed up between 1995–2022. During the study period, 15 women after the Fontan procedure had 26 pregnancies. Among 26 pregnancies, eleven ended with miscarriages, and 15 pregnancies resulted in 16 live births. Fetal complications were observed in 9 (56.3%) live births, with prematurity being the most common complication (n = 7, 43.8%). We recorded 3 (18.8%) neonatal deaths. Obstetrical complications were present in 6 (40%) out of 15 completed pregnancies—two (13.3%) cases of abruptio placentae, two (13.3%) pregnancies with premature rupture of membranes, and two (13.3%) patients with antepartum hemorrhage. There was neither maternal death nor heart failure decompensation during pregnancy. In two (13.3%) women, atrial arrhythmia developed. One (6.7%) patient in the second trimester developed ventricular arrhythmia. None of the patients suffered from systemic thromboembolism during pregnancy. Pregnancy in women after the Fontan procedure is well tolerated. However, it is burdened by a high risk of miscarriage and multiple obstetrical complications. These women require specialized care provided by both experienced cardiologists and obstetricians.

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Section: Discussionsupporting

confidence: 91%

Section: Discussionsupporting

confidence: 73%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Pregnancy Outcomes in Women after the Fontan Procedure

Bartczak-Rutkowska

Tomkiewicz‐Pająk

Kawka-Paciorkowska

et al. 2023

JCM

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“…The placenta is a poorly studied area in this patient group. We recently described a case of a poor outcome in pregnancy in a 'good' Fontan patient, where the placenta was highly abnormal [30]. A small case series [31] has described a variety of placental abnormalities in this patient group, which needs further study and may provide further insights.…”

Section: Foetal Complicationsmentioning

confidence: 94%

Pregnancy in the FONTAN palliation: physiology, management and new insights from bioengineering

Ordóñez

Biglino

Caputo

et al. 2021

J Congenit Heart Dis

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Fontan palliation for the single ventricle results in a challenging and delicate physiological state. At rest, the body adapts to a low cardiac output and high systemic venous pressure. However, when physiological demands increase, such as in the case of exercise or pregnancy, this delicate physiology struggles to adapt due to the inability of the heart to pump blood into the lungs and the consequent lack of augmentation of the cardiac output.Due to the advances in paediatric cardiology, surgery and intensive care, today most patients born with congenital heart disease reach adulthood. Consequently, many women with a Fontan circulation are becoming pregnant and so far data suggest that, although maternal risk is not high, the outcomes are poor for the foetus. Little is known about the reasons for this disparity and how the Fontan circulation adapts to the physiological demands of pregnancy.Here we review current knowledge about pregnancy in Fontan patients and explore the potential role of computational modelling as a means of better understanding this complex physiology in order to potentially improve outcomes, particularly for the foetus.

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