title: Outcome of pregnancy and effects on the right heart in women with repaired tetralogy of fallot.
abstract: BACKGROUND
  Improved medical techniques have allowed most women with repaired tetralogy of Fallot (TOF) to reach childbearing age. The predictors of adverse events and the effects of pregnancy on cardiac function have not been clearly described in these patients.
  
  
  RESULTS
  In the present study we retrospectively reviewed 40 deliveries in 25 patients with repaired TOF. There were 23 patients in New York Heart Association (NYHA) class I, and 2 in classes II-III before pregnancy. The mean age at delivery was 29.1 years and the mean gestational period was 37.8 weeks. Seven pregnancies (17.5%) in 7 patients were complicated with cardiac events such as a decline in NYHA class and arrhythmia. History of ablation and the baseline cardiothoracic ratio on chest radiography were predictors of adverse events. Peak plasma brain natriuretic peptide (BNP) level after the second trimester was higher in patients with cardiac events. Left ventricular size and contraction did not change from before to after pregnancy, but the right ventricle was enlarged at 6 months after delivery.
  
  
  CONCLUSIONS
  Many of the pregnancies in women with repaired TOF were successful. However, careful management is required for some patients and the BNP level may be a useful marker to identify these patients. Because the right heart tended to be enlarged in the late postpartum period, pregnancy may also affect the long-term prognosis of patients with repaired TOF.
authors.affiliation: Department of Perinatology and Gynecology, National Cerebral and Cardiovascular Center, Suita, Japan. chiz@hsp.ncvc.go.jp
authors.forename: Chizuko A
authors.initials: CA
authors.lastname: Kamiya
authors.forename: Tadashi
authors.initials: T
authors.lastname: Iwamiya
authors.forename: Reiko
authors.initials: R
authors.lastname: Neki
authors.forename: Shinji
authors.initials: S
authors.lastname: Katsuragi
authors.forename: Kaoru
authors.initials: K
authors.lastname: Kawasaki
authors.forename: Takakazu
authors.initials: T
authors.lastname: Miyoshi
authors.forename: Yoshihito
authors.initials: Y
authors.lastname: Sasaki
authors.forename: Kazuhiro
authors.initials: K
authors.lastname: Osato
authors.forename: Toyoaki
authors.initials: T
authors.lastname: Murohara
authors.forename: Tomoaki
authors.initials: T
authors.lastname: Ikeda
mesh_terms: D000328:Adult; D015415:Biomarkers / Q000097:blood; D006348:Cardiac Surgical Procedures / Q000009:adverse effects*; D016009:Chi-Square Distribution; D005260:Female; D005865:Gestational Age; D006801:Humans; D017380:Hypertrophy, Right Ventricular / Q000097:blood / Q000175:diagnosis / Q000209:etiology* / Q000503:physiopathology; D007564:Japan; D020097:Natriuretic Peptide, Brain / Q000097:blood; D011247:Pregnancy; D011249:Pregnancy Complications, Cardiovascular / Q000097:blood / Q000175:diagnosis / Q000209:etiology* / Q000503:physiopathology; D011256:Pregnancy Outcome; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D013771:Tetralogy of Fallot / Q000601:surgery*; D013997:Time Factors
chemical_list: D015415:Biomarkers; D020097:Natriuretic Peptide, Brain