Pregnancy in Women with Complex Congenital Heart Disease. A Constant Challenge

Abstract Background: The improvement in surgical techniques has contributed to an increasing number of childbearing women with complex congenital heart disease (CCC). However, adequate counseling about pregnancy in this situation is uncertain, due to a wide variety of residual cardiac lesions. Objectives: To evaluate fetal and maternal outcomes in pregnant women with CCC and to analyze the predictive variables of prognosis. Methods: During 10 years we followed 435 consecutive pregnancies in patients (pts) with congenital heart disease. Among of them, we selected 42 pregnancies in 40 (mean age of 25.5 ± 4.5 years) pts with CCC, who had been advised against pregnancy. The distribution of underlying cardiac lesions were: D-Transposition of the great arteries, pulmonary atresia, tricuspid atresia, single ventricle, double-outlet ventricle and truncus arteriosus. The surgical procedures performed before gestation were: Fontan, Jatene, Rastelli, Senning, Mustard and other surgical techniques, including Blalock, Taussing, and Glenn. Eight (20,0%) pts did not have previous surgery. Nineteen 19 (47.5%) pts had hypoxemia. The clinical follow-up protocol included oxygen saturation recording, hemoglobin and hematocrit values; medication adjustment to pregnancy, anticoagulation use, when necessary, and hospitalization from 28 weeks, in severe cases. The statistical significance level considered was p

摘要 背景：外科手术技术的进步使得合并复杂性先天性心脏病（complex congenital heart disease, CCC）的育龄女性数量持续增加。然而，由于残留心脏病变类型多样，针对此类人群的妊娠咨询方案仍缺乏统一标准。目的：评估合并复杂性先天性心脏病的妊娠女性的胎儿与母体结局，并分析预后相关预测变量。方法：本研究在10年间随访了435例先天性心脏病患者的连续妊娠病例。其中，我们纳入了40例患者（pts，patients的缩写）的42次妊娠，患者平均年龄为25.5±4.5岁，此类人群均曾被临床建议避免妊娠，且均合并复杂性先天性心脏病。其基础心脏病变类型包括：大动脉右转位（D-Transposition of the great arteries）、肺动脉闭锁、三尖瓣闭锁、单心室、双出口心室及永存动脉干。患者妊娠前接受的手术方式包括：Fontan术、Jatene术、Rastelli术、Senning术、Mustard术，以及Blalock、Taussing、Glenn等其他手术术式。其中8例（20.0%）患者未接受过前置手术。19例（47.5%）患者存在低氧血症。临床随访方案包括：血氧饱和度监测、血红蛋白与红细胞比容检测；根据妊娠情况调整用药方案，必要时使用抗凝治疗；重症患者需自妊娠28周起住院观察。本研究设定的统计学显著性判定标准为p