Cardiac disease in pregnancy and repaired congenital heart disease
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Cardiac disease in pregnancy Microchapters |
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor-In-Chief: Anjan K. Chakrabarti, M.D. [2]; Assistant Editor-In Chief: Ara Tachjian, MD [3]
Overview
Most of the patients who undergo surgery for congenital heart disease repair will still have some residua of the defect. Therefore, these should be carefully evaluated prior to pregnancy planning. [1] [2]
Tetralogy of Fallot
Individuals with TOF usually present very early in life with cyanosis making it necessary to have a surgical repair. The repair is is almost always done during infancy particularly in developed countries. During the surgery, the pulmonary valve and right ventricular outflow tract are both surgically dilated. This usually leads to pulmonary valve regurgitation as well as arrhythmias originating from the right side of the heart. Therefore, subsequent right sided heart failure is sometimes observed. 20 years following repair of Tetralogy of Fallot, 10-15% of patients develop late complications, the most important of which is right sided heart failure. [3] [4] [5]
A few of TOF patients might have had a palliative surgically created systemic-pulmonary shunt in the past such as Blalock-Taussig or Waterston, but without corrective surgery.[3] In such situations, pregnancy might worsen an already existing right to left shunt via reducing the peripheral resistance.
References
- ↑ Presbitero P, Somerville J, Stone S, Aruta E, Spiegelhalter D, Rabajoli F (1994). "Pregnancy in cyanotic congenital heart disease. Outcome of mother and fetus". Circulation. 89 (6): 2673–6. PMID 8205680.
- ↑ Zuber M, Gautschi N, Oechslin E, Widmer V, Kiowski W, Jenni R (1999). "Outcome of pregnancy in women with congenital shunt lesions". Heart. 81 (3): 271–5. PMC 1728980. PMID 10026351.
- ↑ 3.0 3.1 Meijer JM, Pieper PG, Drenthen W, Voors AA, Roos-Hesselink JW, van Dijk AP; et al. (2005). "Pregnancy, fertility, and recurrence risk in corrected tetralogy of Fallot". Heart. 91 (6): 801–5. doi:10.1136/hrt.2004.034108. PMC 1768963. PMID 15894783.
- ↑ Murphy JG, Gersh BJ, Mair DD, Fuster V, McGoon MD, Ilstrup DM; et al. (1993). "Long-term outcome in patients undergoing surgical repair of tetralogy of Fallot". N Engl J Med. 329 (9): 593–9. doi:10.1056/NEJM199308263290901. PMID 7688102.
- ↑ Nollert G, Fischlein T, Bouterwek S, Böhmer C, Klinner W, Reichart B (1997). "Long-term survival in patients with repair of tetralogy of Fallot: 36-year follow-up of 490 survivors of the first year after surgical repair". J Am Coll Cardiol. 30 (5): 1374–83. PMID 9350942.