Skip to main content Accessibility help
×
×
Home

Pregnancy in complex CHD: focus on patients with Fontan circulation and patients with a systemic right ventricle*

  • Abigail Khan (a1) and Yuli Y. Kim (a1)
Abstract

The majority of children with congenital heart disease (CHD) now survive into adulthood, and many women with CHD want to pursue pregnancy. Pregnancy represents a complex issue for the CHD care provider. It requires balancing the interests of the woman against the risk to her health during pregnancy, while also factoring in the long-term risks to her health and the risk to her fetus. Our knowledge about this subject has been historically limited by lack of data regarding the outcome of pregnancy in CHD; however, in recent years, more data have begun to emerge. In this review, we will summarise what is known about risk assessment in pregnant CHD patients. We provide a framework for healthcare providers managing pregnancy in this population, with focus on the systemic right ventricle and the Fontan operation.

Copyright
Corresponding author
Correspondence to: Dr Y.Y. Kim, MD, Philadelphia Adult Congenital Heart Center, Perelman School of Medicine at the University of Pennsylvania Philadelphia, PA 19104, United States of America. Tel: 215-615-3388; Fax: 215-349-5927; E-mail: kimy@email.chop.edu
Footnotes
Hide All
*

Presented at the Children’s Hospital of Philadelphia Cardiology 2015: 18th Annual Update on Pediatric and Congenital Cardiovascular Disease: “Challenges and Dilemmas”, Scottsdale, Arizona, United States of America, Wednesday February 11, 2015 – Sunday, February 15, 2015.

Footnotes
References
Hide All
1.Khairy, P, Ionescu-Ittu, R, Mackie, AS, Abrahamowicz, M, Pilote, L, Marelli, AJ. Changing mortality in congenital heart disease. J Am Coll Cardiol 2010; 56: 11491157.
2.Drenthen, W, Pieper, PG, Roos-Hesselink, JW, et al. Outcome of pregnancy in women with congenital heart disease: a literature review. J Am Coll Cardiol 2007; 49: 23032311.
3.Regitz-Zagrosek, V, Blomstrom Lundqvist, C, Borghi, C, et al. EDC guidelines on the management of cardiovascular diseases during pregnancy: the task force on the management of cardiovascular diseases during pregnancy of the European Society of Cardiology (ESC). Eur Heart J 2011; 32: 31473197.
4.Ruys, TP, Roos-Hesselink, JW, Pijuan-Domenech, A, et al. Is a planned caesarean section in women with cardiac disease beneficial? Heart 2015; 101: 530536.
5.Trojnarska, O, Markwitz, W, Katarzynski, S, Gwizdala, A. Pregnancy and delivery in patient after Fontan’s operation due to common ventricle of left ventricular morphology. Int J Cardiol 2007; 114: E63E64.
6.Siu, SC, Sermer, M, Colman, JM, et al. Prospective multicenter study of pregnancy outcomes in women with heart disease. Circulation 2001; 104: 515521.
7.Balci, A, Sollie-Szarynska, KM, van der Bijl, AG, et al. Prospective validation and assessment of cardiovascular and offspring risk models for pregnant women with congenital heart disease. Heart 2014; 100: 13731381.
8.Drenthen, W, Boersma, E, Balci, A, et al. Predictors of pregnancy complications in women with congenital heart disease. Eur Heart J 2010; 31: 21242132.
9.Khairy, P, Ouyang, DW, Fernandes, SM, Lee-Parritz, A, Economy, KE, Landzberg, MJ. Pregnancy outcomes in women with congenital heart disease. Circulation 2006; 113: 517524.
10.Ohuchi, H, Arakaki, Y, Yagihara, T, Kamiya, T. Cardiorespiratory responses to exercise after repair of the univentricular heart. Int J Cardiol 1997; 58: 1730.
11.Lui, GK, Silversides, CK, Khairy, P, et al. Heart rate response during exercise and pregnancy outcome in women with congenital heart disease. Circulation 2011; 123: 242248.
12.Presbitero, P, Somerville, J, Stone, S, Aruta, E, Spiegelhalter, D, Rabajoli, F. Pregnancy in cyanotic congenital heart disease. Outcome of mother and fetus. Circulation 1994; 89: 26732676.
13.Inoue, S, Masuyama, H, Akagi, T, Hiramatsu, Y. Pregnancy and delivery in patients with Fontan circulation: a report of two cases. J Obstet Gynaecol Res 2013; 39: 378382.
14.Hoffman, SL, Crochetiere, C, Lesage, S. Urgent cesarean delivery and prolonged ventilatory support in a parturient with Fontan circulation and undiagnosed pseudocholinesterase deficiency. Int J Obstet Anesth 2012; 21: 281282.
15.Caruana, M, Grech, V, Somerville, J. Pregnancy in atriopulmonary connection and total cavopulmonary connection – a comparison of two cases. Cardiol Young 2012; 22: 600602.
16.Nitsche, JF, Phillips, SD, Rose, CH, Brost, BC, Watson, WJ. Pregnancy and delivery in patients with Fontan circulation: a case report and review of obstetric management. Obstet Gynecol Surv 2009; 64: 607614.
17.Suchonska, B, Borowiecka, E, Szymusik, I, Krzemien-Wiczynska, S, Borowiecka-Elwertowska, A. The course of pregnancy and delivery in a patient after a double-outlet right ventricle Fontan repair and the influence of this procedure on her general condition: report of a case. Surg Today 2008; 38: 853856.
18.Ito, M, Takagi, N, Sugimoto, S, Oosawa, H, Abe, T. Pregnancy after undergoing the Fontan procedure for a double outlet right ventricle: report of a case. Surg Today 2002; 32: 6365.
19.Hoare, JV, Radford, D. Pregnancy after Fontan repair of complex congenital heart disease. Aust NZ J Obstet Gynaecol 2001; 41: 464468.
20.Lao, TT, Sermer, M, Colman, JM. Pregnancy after the Fontan procedure for tricuspid atresia. A case report. J Reprod Med 1996; 41: 287290.
21.Hess, DB, Hess, LW, Heath, BJ, et al. Pregnancy after Fontan repair of tricuspid atresia. South Med J 1991; 84: 532534.
22.Opotowsky, AR, Shellenberger, D, Dharan, V, et al. Successful pregnancies in two women with hypoplastic left heart syndrome. Congenit Heart Dis 2010; 5: 476481.
23.Gouton, M, Nizard, J, Patel, M, et al. Maternal and fetal outcomes of pregnancy with fontan circulation: a multicentric observational study. Int J Cardiol 2015; 187: 8489.
24.Drenthen, W, Pieper, PG, Roos-Hesselink, JW, et al. Pregnancy and delivery in women after Fontan palliation. Heart 2006; 92: 12901294.
25.Jain, VD, Moghbeli, N, Webb, G, Srinivas, SK, Elovitz, MA, Pare, E. Pregnancy in women with congenital heart disease: the impact of a systemic right ventricle. Congenit Heart Dis 2011; 6: 147156.
26.Guedes, A, Mercier, LA, Leduc, L, Berube, L, Marcotte, F, Dore, A. Impact of pregnancy on the systemic right ventricle after a Mustard operation for transposition of the great arteries. J Am Coll Cardiol 2004; 44: 433437.
27.Connolly, HM, Grogan, M, Warnes, CA. Pregnancy among women with congenitally corrected transposition of great arteries. J Am Coll Cardiol 1999; 33: 16921695.
28.Gelson, E, Curry, R, Gatzoulis, MA, et al. Pregnancy in women with a systemic right ventricle after surgically and congenitally corrected transposition of the great arteries. Eur J Obstet Gynecol Reprod Biol 2011; 155: 146149.
29.Bowater, SE, Selman, TJ, Hudsmith, LE, Clift, PF, Thompson, PJ, Thorne, SA. Long-term outcome following pregnancy in women with a systemic right ventricle: is the deterioration due to pregnancy or a consequence of time? Congenit Heart Dis 2013; 8: 302307.
30.Kowalik, E, Klisiewicz, A, Biernacka, EK, Hoffman, P. Pregnancy and long-term cardiovascular outcomes in women with congenitally corrected transposition of the great arteries. Int J Gynaecol Obstet 2014; 125: 154157.
31.Canobbio, MM, Morris, CD, Graham, TP, Landzberg, MJ. Pregnancy outcomes after atrial repair for transposition of the great arteries. Am J Cardiol 2006; 98: 668672.
32.Zentner, D, Wheeler, M, Grigg, L. Does pregnancy contribute to systemic right ventricular dysfunction in adults with an atrial switch operation? Heart Lung Circ 2012; 21: 433438.
33.Fiedler, K, Ezcurra, D. Predicting and preventing ovarian hyperstimulation syndrome: the need for individualized not standardized treatment. Reprod Biol Endocrinol 2012; 10: 32.
34.Ohuchi, H, Tanabe, Y, Kamiya, C, et al. Cardiopulmonary variables during exercise predict pregnancy outcome in women with congenital heart disease. Circ J 2013; 77: 470476.
35.Roos-Hesselink, JW, Ruys, TP, Stein, JI, et al. Outcome of pregnancy in patients with structural or ischaemic heart disease: Results of a registry of the European Society of Cardiology. Eur Heart J 2013; 34: 657665.
Recommend this journal

Email your librarian or administrator to recommend adding this journal to your organisation's collection.

Cardiology in the Young
  • ISSN: 1047-9511
  • EISSN: 1467-1107
  • URL: /core/journals/cardiology-in-the-young
Please enter your name
Please enter a valid email address
Who would you like to send this to? *
×

Keywords

Metrics

Full text views

Total number of HTML views: 0
Total number of PDF views: 0 *
Loading metrics...

Abstract views

Total abstract views: 0 *
Loading metrics...

* Views captured on Cambridge Core between <date>. This data will be updated every 24 hours.

Usage data cannot currently be displayed