Outcomes of pregnancy in women with tetralogy of Fallot.
OBJECTIVE
We sought to determine pregnancy outcomes in patients with tetralogy of Fallot (TOF).


BACKGROUND
Pregnancy outcomes in patients with TOF are incompletely defined.


METHODS
Clinical, hemodynamic, and obstetric data were reviewed for women with TOF and prior pregnancy.


RESULTS
Of 72 respondents, 43 (mean age, 26 years) had 112 pregnancies (range, 1 to 5); 82 pregnancies were successful. Eight women had unrepaired TOF at the time of their 20 successful pregnancies. At first assessment (age > or =18 years), six patients had pulmonary hypertension, three had moderate or severe right ventricular (RV) systolic dysfunction, and 13 had severe RV dilation due to pulmonic regurgitation. Sixteen patients had 30 miscarriages (27%) and one term stillbirth. Mean overall birth weight was 3.2 kg (range, 2.1 to 4.2 kg). Unrepaired TOF (p = 0.05) and morphologic pulmonary artery abnormality (p = 0.03) were independently predictive of infant birth weight. Six patients had cardiovascular complications during pregnancy: supraventricular tachycardia in two, heart failure in two, pulmonary embolism in a patient with pulmonary hypertension, and progressive RV dilation in a patient with severe pulmonic regurgitation. Five infants (6%) had congenital anomalies.


CONCLUSIONS
Patients with TOF have an increased risk of fetal loss, and their offspring are more likely to have congenital anomalies than offspring in the general population. Adverse maternal events, although rare, may be associated with left ventricular dysfunction, severe pulmonary hypertension, and severe pulmonic regurgitation with RV dysfunction.
Veldtman
Gruschen R
GR
Division of Cardiovascular Diseases and Internal Medicine, Mayo Clinic, Rochester, Minnesota 55905, USA.
Connolly
Heidi M
HM
Grogan
Martha
M
Ammash
Naser M
NM
Warnes
Carole A
CA
D000328:Adult; D001013:Aorta, Thoracic / Q000473:pathology / Q000601:surgery; D006348:Cardiac Surgical Procedures; D003330:Coronary Vessel Anomalies / Q000175:diagnosis / Q000601:surgery; D005260:Female; D005500:Follow-Up Studies; D006345:Heart Septal Defects, Ventricular / Q000503:physiopathology / Q000601:surgery; D006801:Humans; D008429:Maternal Welfare; D008910:Minnesota; D011247:Pregnancy; D011249:Pregnancy Complications, Cardiovascular / Q000175:diagnosis* / Q000209:etiology / Q000401:mortality / Q000601:surgery; D011256:Pregnancy Outcome; D011651:Pulmonary Artery / Q000473:pathology / Q000601:surgery; D013318:Stroke Volume / Q000502:physiology; D016019:Survival Analysis; D013771:Tetralogy of Fallot / Q000175:diagnosis* / Q000401:mortality / Q000601:surgery; D016896:Treatment Outcome; D018487:Ventricular Dysfunction, Left / Q000503:physiopathology / Q000601:surgery; D014694:Ventricular Outflow Obstruction / Q000503:physiopathology / Q000601:surgery; D017725:Ventricular Pressure / Q000502:physiology