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Paediatric-onset coronary artery anomalies in pregnancy: a single-centre experience and systematic literature review

Published online by Cambridge University Press:  17 April 2017

Michelle Keir ,
Catriona Bhagra ,
Debra Vatenmakher ,
Francisca Arancibia-Galilea ,
Katrijn Jansen ,
Norihisa Toh ,
Candice K. Silversides ,
Jack Colman ,
Samuel C. Siu  and
Mathew Sermer
...Show all authors
Michelle Keir
Affiliation:
Toronto Congenital Cardiac Centre for Adults, Toronto General Hospital, University of Toronto, Toronto, Ontario, Canada
Catriona Bhagra
Affiliation:
Division of Cardiology, Pregnancy and Heart Disease Program, Mount Sinai Hospital, Toronto, Ontario, Canada
Debra Vatenmakher
Affiliation:
Toronto Congenital Cardiac Centre for Adults, Toronto General Hospital, University of Toronto, Toronto, Ontario, Canada
Francisca Arancibia-Galilea
Affiliation:
Toronto Congenital Cardiac Centre for Adults, Toronto General Hospital, University of Toronto, Toronto, Ontario, Canada
Katrijn Jansen
Affiliation:
Toronto Congenital Cardiac Centre for Adults, Toronto General Hospital, University of Toronto, Toronto, Ontario, Canada
Norihisa Toh
Affiliation:
Toronto Congenital Cardiac Centre for Adults, Toronto General Hospital, University of Toronto, Toronto, Ontario, Canada
Candice K. Silversides
Affiliation:
Toronto Congenital Cardiac Centre for Adults, Toronto General Hospital, University of Toronto, Toronto, Ontario, Canada Division of Cardiology, Pregnancy and Heart Disease Program, Mount Sinai Hospital, Toronto, Ontario, Canada
Jack Colman
Affiliation:
Toronto Congenital Cardiac Centre for Adults, Toronto General Hospital, University of Toronto, Toronto, Ontario, Canada Division of Cardiology, Pregnancy and Heart Disease Program, Mount Sinai Hospital, Toronto, Ontario, Canada
Samuel C. Siu
Affiliation:
Division of Cardiology, Pregnancy and Heart Disease Program, Mount Sinai Hospital, Toronto, Ontario, Canada Division of Cardiology, Schulich School of Medicine & Dentistry, Western University, London, Ontario, Canada
Mathew Sermer
Affiliation:
Division of Obstetrics, Mount Sinai Hospital, University of Toronto, Toronto
Andrew M. Crean
Affiliation:
Toronto Congenital Cardiac Centre for Adults, Toronto General Hospital, University of Toronto, Toronto, Ontario, Canada Joint Department of Medical Imaging, Toronto General Hospital, Ontario, Canada
Rachel M. Wald*
Affiliation:
Toronto Congenital Cardiac Centre for Adults, Toronto General Hospital, University of Toronto, Toronto, Ontario, Canada Division of Cardiology, Pregnancy and Heart Disease Program, Mount Sinai Hospital, Toronto, Ontario, Canada
*
Correspondence to: R. M. Wald, Toronto Congenital Cardiac Centre for Adults, Toronto General Hospital, University of Toronto, 585 University Avenue, 5N 517, Toronto, Ontario, Canada, M5G 2N2. Tel: +416 340 5502; Fax: +416 340 5014; E-mail: rachel.wald@uhn.ca
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Abstract

Objectives

Individuals with childhood-onset coronary artery anomalies are at increased risk of lifelong complications. Although pregnancy is thought to confer additional risk, a few data are available regarding outcomes in this group of women. We sought to define outcomes of pregnancy in this unique population.

Methods

We performed a retrospective survey of women with paediatric-onset coronary anomalies and pregnancy in our institution, combined with a systematic review of published cases. We defined paediatric-onset coronary artery anomalies as congenital coronary anomalies and inflammatory arteriopathies of childhood that cause coronary aneurysms. Major cardiovascular events were defined as pulmonary oedema, sustained arrhythmia requiring treatment, stroke, myocardial infarction, cardiac arrest, or death.

Results

A total of 25 surveys were mailed, and 20 were returned (80% response rate). We included 46 articles from the literature, which described cardiovascular outcomes in 82 women (138 pregnancies). These data were amalgamated for a total of 102 women and 194 pregnancies; 59% of women were known to have paediatric-onset coronary artery anomalies before pregnancy. In 23%, the anomaly was unmasked during or shortly after pregnancy. The remainder, 18%, was diagnosed later in life. Major cardiovascular events occurred in 14 women (14%) and included heart failure (n=5, 5%), myocardial infarction (n=7, 7%), maternal death (n=2, 2%), cardiac arrest secondary to ventricular fibrillation (n=1, 1%), and stroke (n=1, 1%). The majority of maternal events (13/14, 93%) occurred in women with no previous diagnosis of coronary disease.

Conclusions

Women with paediatric-onset coronary artery anomalies have a 14% risk of adverse cardiovascular events in pregnancy, indicating the need for careful assessment and close follow-up. Prospective, multicentre studies are required to better define risk and predictors of complications during pregnancy.

Keywords

Congenital coronary anomaliesanomalous aortic origin of a coronary arteryanomalous left coronary artery from the pulmonary arteryKawasaki diseasepregnancy outcomes
Type
Original Articles
Information
Cardiology in the Young , Volume 27 , Issue 8 , October 2017 , pp. 1529 - 1537
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Copyright
© Cambridge University Press 2017 

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