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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Article info
Publication history
Accepted:
March 9,
2010
Received in revised form:
March 9,
2010
Received:
January 22,
2010
Footnotes
This work was supported by Grants 53130 and 93722 from the Canadian Institutes of Health Research, Ottawa, Ontario, Canada, Grants NA 5662 and 5927 from the Heart and Stroke Foundation of Canada, Ottawa, Ontario, Canada, The Ramsay Gunton Professorship in Cardiology from the Schulich School of Medicine and Dentistry (Dr. Siu), London, Ontario, Canada and a generous donation from Mrs. Josephine Rogers.
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Copyright
© 2010 Elsevier Inc. Published by Elsevier Inc. All rights reserved.
