Download Impact of Pregnancy in Women after Atrial Repair for Transposition

IMPACT OF PREGNANCY IN WOMEN AFTER ATRIAL REPAIR FOR

TRANSPOSITION OF THE GREAT ARTERIES.
V. Pedrosa1 , A. Pijuan2, L. Dos2, M. Goya3, F. Baró3, L.Galian4 , M.Subirana 5 J. Casaldàliga2. 1 Cardiology Department, Hospital Manises, Valencia.
2Adult Congenital Heart Disease Unit (ACHD), 3Gynecology and Obstetric Department, , 4 Cardiology Department. Hospital Universitario Vall
d'Hebron, Barcelona and 5ACHD, Hospital de la Santa Creu i Sant Pau, Barcelona
Women who underwent to atrial switch procedure for repair of transposition of the great
arteries (TGA) are now in reproductive age.
Atrial baffle leaks and obstruction.
Supraventricular arrhythmias:
• Synus disfunction.
• Tachyarrhythmias.
Tricuspid regurgitation.
Systemic Right ventricle:
progressive dilation and
dysfunction.
Asymptomatic
 Exercise capacity
• Cardiac output
SV Heart rate
• Vascular resistance
• Arterial pressure
•  Systolic function
• Delivery
Clinical deterioration
RV deterioration
¿irreversible?
High risk
ESC Guidelines on the management of cardiovascular
diseases during pregnancy
Objective
The aim it is to report the pregnancy outcomes of the patients with
atrial switch surgery for Transposition of the Great Arteries of an
Adolescent and Adult Congenital Heart Disease Unit
Methods
Review clinical and echocardiographic data before, during and
after pregnancy and the obstetric outcomes.
 Before 2007: retrospective collection data.
 After 2007: prospective.
Counseling reproductive and high risk pregnancy consultation.
Close follow- up: clinical and echocardiographic monthly review.
Obstetric Control
Specifical considerations in the delivery and puerperium for each patient.
Results
1996-2011: 14 women had 17 pregnancies with 14 newborns.

Maternal status prepregnancy
Clinica data before pregnancy
Age (years)
27,9 (18 – 33)
Surgery
8 Mustard // 6 Senning
12  1 surgery
2  1 redo the Mustard /1 minor surgery
Time since surgery (years)
26,2 (17 -32)
Functional Class (NYHA)
I
II
10 (71,4%) (Mean age 23,7 years)
4 (28,6%) (Mean age 31,1 years)
Heart failure medication
None
(stenortomy cleaning)
Results

Maternal status prepregnancy
Cardiopathy status by echo data
* Magnetic Resonance
Right ventricular function
14 preserved
Right ventricular dilation
13 mild dilation
1 moderate dilation
Tricuspid regurgitation
3 none
8 mild
3 mild to moderate
Subpulmonar obstruction
2 moderate
Baffle leak
3 mild
Baffle obstruction
Systemic venous
Pulmonary venous
2 mild
1 mild
1 moderate ------------------------ 1 moderate
*MR 4 patients: RV EF mean =55%
Results

Maternal status prepregnancy
Rhythm profile
Arrhythmia
5
4 atrial flutter + 4 synus dysfunction
1 complete AVB(2nd surgery) + supraventricular tachycardia
Pacemaker
1 active pacemaker during pregnancy
• 1 epicardical leads without generator
• 1 epicardical leads + generator depleted without
replacement
Cardiac medications:
antiarrhythmic
4
2 digitalis
1 atenolol
1 amiodarona stop
Results

Obstetric and fetal outcomes
Obstetric data
Pregnancy outcomes
17 pregnancies
14 newborns
3 spontaneous abortions
Gestational age
38,1 weeks (36-40,1)
Delivery
8 spontaneous delivery
6 instrumental
4 (28,6%) induction of labor
2 (12,3%) cesarean section (podalic possition)
Obstetric complications
1 minor hematoma
Fetal outcomes
Birth weight (g)
2687,5 mg (2140-3420)
3 infants < 2500 g
APGAR
13 infants APGAR 9
1 infants APGAR 4
Congenital heart disease
0
Results

Maternal status during and after pregnancy
Functional class (NYHA)
Right ventricular dimensions and
function
2* (12,3%) deterioration:
Class pre II  during III
Class pre I  during III
ACEis+BB
 postpartum  II
 postpartum  II
2* (12,3%) Dilation and Deterioration.
Mild
 moderated dilated
 No changes
Preserved  moderated dysfunction  Mild dysfunction
*MRI: 55% EF-------------------------------------41% EF
No clinical changes
3 (21,4%) Deterioration RV function
Preserved  mild dysfunction  2 recuperation postpartum.
Arrhythmias
1 Autolimit supraventricular arryhtmia during pregnancy
1 Rapid atrial flutter in puerperium
Mortality
1 (7,1%) death in the puerperium for rapid atrial flutter 
cardiogenic shock
Conclusions
Pregnancy after atrial repair in TGA carries a moderate risk
and requires a caution follow-up, which should start in the
reproductive counseling, continues during pregnancy and the
postpartum.
The complications rate could be low if:
 Good functional class.
 Normal right ventricle systolic function, atlhough deterioration
could be possible.
 Special attention to arrhythmias.