title: Hypoplastic right-heart syndrome presenting as multiple miscarriages.
abstract: Reversible causes of miscarriage are many, but they affect only 1% of women who are trying to conceive. Herein, we describe the case of a 23-year-old woman who presented for evaluation of repeated miscarriages and was found to have hypoxemia and erythrocytosis. Further evaluation revealed hypoplastic right-heart syndrome with an intracardiac shunt. She underwent hybrid repair with pulmonary valve balloon valvuloplasty, followed by surgery to perform atrial septal defect closure and a Glenn anastomosis. The erythrocytosis and hypoxemia resolved, and she was able to conceive and deliver a healthy baby at term 2 years later. This is a unique case of a rare congenital heart defect that went unnoticed until adulthood, when attempts at pregnancy failed because of the associated hypoxemia. Timely and appropriate treatment led to a successful pregnancy after repeated miscarriages. This case exemplifies the need for a comprehensive medical evaluation of every woman with a history of multiple miscarriages to determine whether a reversible cause exists.
authors: Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota 55905, USA.
authors: Chadi
authors: C
authors: Dib
authors: Philip A
authors: PA
authors: Araoz
authors: Norman P
authors: NP
authors: Davies
authors: Joseph A
authors: JA
authors: Dearani
authors: Naser M
authors: NM
authors: Ammash
mesh_terms: D000015:Abnormalities, Multiple; D000026:Abortion, Habitual / Q000209:etiology*; D063126:Balloon Valvuloplasty; D006328:Cardiac Catheterization; D006348:Cardiac Surgical Procedures; D018618:Echocardiography, Doppler, Color; D005260:Female; D006330:Heart Defects, Congenital / Q000150:complications / Q000175:diagnosis* / Q000503:physiopathology / Q000628:therapy; D006344:Heart Septal Defects, Atrial / Q000150:complications / Q000175:diagnosis; D006352:Heart Ventricles / Q000002:abnormalities* / Q000503:physiopathology; D006439:Hemodynamics; D006801:Humans; D000860:Hypoxia / Q000209:etiology; D050498:Live Birth; D008279:Magnetic Resonance Imaging; D011086:Polycythemia / Q000209:etiology; D011247:Pregnancy; D011249:Pregnancy Complications, Cardiovascular / Q000175:diagnosis* / Q000503:physiopathology / Q000628:therapy; D011666:Pulmonary Valve Stenosis / Q000150:complications / Q000175:diagnosis; D013577:Syndrome; D016896:Treatment Outcome; D014261:Tricuspid Valve / Q000002:abnormalities; D055815:Young Adult