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Pregnancy Outcomes in Women With Transposition of the Great Arteries and Arterial Switch Operation

      There is a growing population of young women of child-bearing age with complete transposition of the great arteries (TGA) who have had an arterial switch operation (ASO). Pregnancy imposes a hemodynamic stress on the heart and, therefore, adverse cardiac events can occur during this period; however, pregnancy outcomes in this population have not been well studied. We sought to describe cardiac outcomes during pregnancy in women with TGA who had undergone an ASO in childhood. Women were identified from 2 large tertiary care hospitals. A retrospective chart review was performed to determine the prevalence of adverse maternal cardiac events during pregnancy. Overall, 74 women of child-bearing age were identified, 9 of whom had 17 pregnancies. There were 4 miscarriages. Six women (67%) had clinically important valve (n = 5) and ventricular (n = 1) lesions before the index pregnancy. Two women developed cardiac complications during pregnancy; 1 woman with impaired left ventricular systolic function had nonsustained ventricular tachycardia and 1 woman with a mechanical systemic atrioventricular valve developed postpartum valve thrombosis. There were no maternal deaths. In conclusion, young women with TGA from this early cohort repaired with ASO are reaching child-bearing age. A significant proportion have residua and/or sequelae that can confer risk for adverse cardiac events in pregnancy. Co-ordinated care between a congenital heart disease specialist and a high-risk obstetrician should be implemented.
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      References

        • Jatene A.D.
        • Fontes V.F.
        • Paulista P.P.
        • Souza L.C.
        • Neger F.
        • Galantier M.
        • Sousa J.E.
        Anatomic correction of transposition of the great vessels.
        J Thorac Cardiovasc Surg. 1976; 72: 364-370
        • Schwartz M.L.
        • Gauvreau K.
        • del Nido P.
        • Mayer J.E.
        • Colan S.D.
        Long-term predictors of aortic root dilation and aortic regurgitation after arterial switch operation.
        Circulation. 2004; 110: II128-II132
        • Angeli E.
        • Raisky O.
        • Bonnet D.
        • Sidi D.
        • Vouhe P.R.
        Late reoperations after neonatal arterial switch operation for transposition of the great arteries.
        Eur J Cardiothorac Surg. 2008; 34: 32-36
        • Legendre A.
        • Losay J.
        • Touchot-Kone A.
        • Serraf A.
        • Belli E.
        • Piot J.D.
        • Lambert V.
        • Capderou A.
        • Planche C.
        Coronary events after arterial switch operation for transposition of the great arteries.
        Circulation. 2003; 108: II186-II190
        • Klein L.L.
        • Galan H.L.
        Cardiac disease in pregnancy.
        Obstet Gynecol Clin North Am. 2004; 31: 429-459
        • Lang R.M.
        • Bierig M.
        • Devereux R.B.
        • Flachskampf F.A.
        • Foster E.
        • Pellikka P.A.
        • Picard M.H.
        • Roman M.J.
        • Seward J.
        • Shanewise J.S.
        • Solomon S.D.
        • Spencer K.T.
        • Sutton M.S.
        • Stewart W.J.
        Recommendations for chamber quantification: a report from the American Society of Echocardiography's Guidelines and Standards Committee and the Chamber Quantification Writing Group, developed in conjunction with the European Association of Echocardiography, a branch of the European Society of Cardiology.
        J Am Soc Echocardiogr. 2005; 18: 1440-1463
        • Bonow R.O.
        • Carabello B.A.
        • Chatterjee K.
        • de Leon Jr, A.C.
        • Faxon D.P.
        • Freed M.D.
        • Gaasch W.H.
        • Lytle B.W.
        • Nishimura R.A.
        • O'Gara P.T.
        • O'Rourke R.A.
        • Otto C.M.
        • Shah P.M.
        • Shanewise J.S.
        2008 Focused update incorporated into the ACC/AHA 2006 guidelines for the management of patients with valvular heart disease: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to revise the 1998 guidelines for the management of patients with valvular heart disease).
        J Am Coll Cardiol. 2008; 52: e1-e142
        • Lecompte Y.
        • Neveux J.Y.
        • Leca F.
        • Zannini L.
        • Tu T.V.
        • Duboys Y.
        • Jarreau M.M.
        Reconstruction of the pulmonary outflow tract without prosthetic conduit.
        J Thorac Cardiovasc Surg. 1982; 84: 727-733
        • Drenthen W.
        • Pieper P.G.
        • Roos-Hesselink J.W.
        • van Lottum W.A.
        • Voors A.A.
        • Mulder B.J.
        • van Dijk A.P.
        • Vliegen H.W.
        • Yap S.C.
        • Moons P.
        • Ebels T.
        • van Veldhuisen D.J.
        Outcome of pregnancy in women with congenital heart disease: a literature review.
        J Am Coll Cardiol. 2007; 49: 2303-2311
        • Drenthen W.
        • Pieper P.G.
        • Ploeg M.
        • Voors A.A.
        • Roos-Hesselink J.W.
        • Mulder B.J.
        • Vliegen H.W.
        • Sollie K.M.
        • Ebels T.
        • van Veldhuisen D.J.
        Risk of complications during pregnancy after Senning or Mustard (atrial) repair of complete transposition of the great arteries.
        Eur Heart J. 2005; 26: 2588-2595
        • Siu S.C.
        • Sermer M.
        • Harrison D.A.
        • Grigoriadis E.
        • Liu G.
        • Sorensen S.
        • Smallhorn J.F.
        • Farine D.
        • Amankwah K.S.
        • Spears J.C.
        • Colman J.M.
        Risk and predictors for pregnancy-related complications in women with heart disease.
        Circulation. 1997; 96: 2789-2794
        • Guedes A.
        • Mercier L.A.
        • 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: 433-437
        • Siu S.C.
        • Sermer M.
        • Colman J.M.
        • Alvarez A.N.
        • Mercier L.A.
        • Morton B.C.
        • Kells C.M.
        • Bergin M.L.
        • Kiess M.C.
        • Marcotte F.
        • Taylor D.A.
        • Gordon E.P.
        • Spears J.C.
        • Tam J.W.
        • Amankwah K.S.
        • Smallhorn J.F.
        • Farine D.
        • Sorensen S.
        Prospective multicenter study of pregnancy outcomes in women with heart disease.
        Circulation. 2001; 104: 515-521
        • Ploeg M.
        • Drenthen W.
        • van Dijk A.
        • Pieper P.G.
        Successful pregnancy after an arterial switch procedure for complete transposition of the great arteries.
        BJOG. 2006; 113: 243-244
        • Chan W.S.
        • Anand S.
        • Ginsberg J.S.
        Anticoagulation of pregnant women with mechanical heart valves: a systematic review of the literature.
        Arch Intern Med. 2000; 160: 191-196
        • Losay J.
        • Touchot A.
        • Serraf A.
        • Litvinova A.
        • Lambert V.
        • Piot J.D.
        • Lacour-Gayet F.
        • Capderou A.
        • Planche C.
        Late outcome after arterial switch operation for transposition of the great arteries.
        Circulation. 2001; 104: I121-I126
        • Hauser M.
        • Bengel F.M.
        • Kuhn A.
        • Sauer U.
        • Zylla S.
        • Braun S.L.
        • Nekolla S.G.
        • Oberhoffer R.
        • Lange R.
        • Schwaiger M.
        • Hess J.
        Myocardial blood flow and flow reserve after coronary reimplantation in patients after arterial switch and Ross operation.
        Circulation. 2001; 103: 1875-1880
        • James A.H.
        • Jamison M.G.
        • Biswas M.S.
        • Brancazio L.R.
        • Swamy G.K.
        • Myers E.R.
        Acute myocardial infarction in pregnancy: a United States population-based study.
        Circulation. 2006; 113: 1564-1571
        • Roth A.
        • Elkayam U.
        Acute myocardial infarction associated with pregnancy.
        Ann Intern Med. 1996; 125: 751-762
        • Pyeritz R.E.
        Maternal and fetal complications of pregnancy in the Marfan syndrome.
        Am J Med. 1981; 71: 784-790