Cardiac complications relating to pregnancy and recurrence of disease in the offspring of women with atrioventricular septal defects.
OBJECTIVE
In most pregnancy reports, atrioventricular septal defects (AVSD) are not differentiated from more simple septal defects, thus underestimating the risks of pregnancy. To investigate the magnitude and determinants of risk during pregnancy in female patients with balanced AVSD.


RESULTS
Using a nation-wide registry (CONCOR), 79 female patients with balanced/isolated AVSD were identified. A total of 29 patients had 62 pregnancies, including 12 miscarriages (19%) and two elective abortions. Detailed recordings of each completed (>20 weeks gestation) pregnancy (n=48, 26 women) were obtained. Cardiovascular events complicated almost 40% of the completed pregnancies. In particular, post-partum persistence of pregnancy-related New York Heart Association (NYHA) class deterioration [23% mainly patients with residual atrial septal defects (ASD)] and deterioration of pre-existing left AV-valvular regurgitation (17%) were frequently recorded. Additional cardiac complications were arrhythmias (19%) and symptomatic heart failure (2%). Congenital heart disease (CHD) recurred in six children (12%): AVSD (n=4, three with left-sided hypoplasia), patent ductus arteriosus (n=1), and ASD (n=1). Three children died including two children with left-sided hypoplasia.


CONCLUSIONS
Pregnancy is not always well tolerated in women with AVSD, predominantly due to NYHA class deterioration and worsening of pre-existing AV-valvular regurgitation. Offspring mortality is high (6.3%), primarily due to recurrence of complex CHD.
Drenthen
Willem
W
Department of Cardiology, University Medical Centre Groningen, PO Box 30.001, 9700 RB Groningen, The Netherlands. w.drenthen@thorax.umcg.nl
Pieper
Petronella G
PG
van der Tuuk
Karin
K
Roos-Hesselink
Jolien W
JW
Voors
Adriaan A
AA
Mostert
Bianca
B
Mulder
Barbara J M
BJ
Moons
Philip
P
Ebels
Tjark
T
van Veldhuisen
Dirk J
DJ
D000328:Adult; D003327:Coronary Disease / Q000209:etiology*; D005260:Female; D006343:Heart Septal Defects; D006801:Humans; D046110:Hypertension, Pregnancy-Induced / Q000209:etiology; D007231:Infant, Newborn; D007247:Infertility, Female / Q000209:etiology*; D010375:Pedigree; D011225:Pre-Eclampsia / Q000209:etiology; D011247:Pregnancy; D011249:Pregnancy Complications, Cardiovascular; D011256:Pregnancy Outcome; D012307:Risk Factors