Pregnancy outcome in women with congenital heart disease and residual haemodynamic lesions of the right ventricular outflow tract.
OBJECTIVE
To determine pregnancy outcome and risk factors for adverse events in women with congenital heart disease (CHD) and residual haemodynamic right ventricular (RV) outflow tract (RVOT) lesions.


RESULTS
Pregnancy outcome data for women with CHD and residual RVOT lesions have been recorded since 2001. There were 76 pregnancies in 47 women that continued beyond 24 weeks gestation. At conception 20% had RVOT obstruction, 32% had pulmonary regurgitation (PR) and 49% had mixed RVOT obstruction and PR. Moderate-to-severe PR was present in 30 (39%) and RVOT obstruction > or =30 mmHg in 12 (16%) of pregnancies. Seven pregnancies (9%) were complicated by right heart failure (RHF). No arrhythmias were documented. Predictors for RHF were moderate-to-severe PR in combination with at least one additional risk factor (twin pregnancy, branch pulmonary artery stenosis, RV systolic dysfunction, RV hypertrophy). All patients responded to diuretic treatment and had a good pregnancy outcome without foetal complications.


CONCLUSIONS
In patients with CHD and residual RVOT lesions, the outcome of pregnancy is good. Patients with moderate-to-severe PR were at risk for symptomatic RHF only if additional risk factors were present. When treated by a multidisciplinary team, maternal and foetal outcome was good. The general recommendation that pulmonary valve replacement should be undertaken prior to pregnancy in patients with moderate-to-severe PR and RV dilatation needs to be reconsidered.
The Grown Up Congenital Heart Disease Unit, The Heart Hospital, University College London Hospitals (UCLH) NHS Trust, London, UK.
Matthias
M
Greutmann
Katherine
K
Von Klemperer
Ruth
R
Brooks
Donald
D
Peebles
Patrick
P
O'Brien
Fiona
F
Walker
D000328:Adult; D001145:Arrhythmias, Cardiac / Q000209:etiology; D005260:Female; D006330:Heart Defects, Congenital / Q000150:complications* / Q000503:physiopathology; D006333:Heart Failure / Q000209:etiology; D006349:Heart Valve Diseases / Q000209:etiology; D006439:Hemodynamics / Q000502:physiology; D006801:Humans; D007231:Infant, Newborn; D011247:Pregnancy; D011249:Pregnancy Complications, Cardiovascular / Q000503:physiopathology; D011256:Pregnancy Outcome; D012307:Risk Factors; D014694:Ventricular Outflow Obstruction / Q000209:etiology* / Q000503:physiopathology; D055815:Young Adult