title: Gender differences and role of pregnancy in the history of post-surgical women affected by tetralogy of Fallot.
abstract: BACKGROUND
  The aim of this study was to describe gender differences in patients operated on for TOF and to define the impact of pregnancy in late post-surgical follow-up in women.
  
  
  METHODS
  In this research, we studied 145 patients after correction of TOF: 66 male, 79 women, 41 of which reported history of 68 pregnancies, means age 37±10 years, age at operation 7±8 years, mean duration of post-surgical follow-up 30±7 years. Selected variables were compared according to sex and according to history of pregnancy with statistical tests.
  
  
  RESULTS
  Men had more severe hemodynamic impairment and a higher number of cardiac reoperations than females. 41% of patients had at least one complication during pregnancy; there were 16 (67%) abortions and 39 (74%) Caesarian delivers; the recurrence of congenital heart defect was 10%. After pregnancy, there was a shift from first to second functional class: unique pregnancy determined no differences in term of morpho-functional ventricular features compared to nulliparous, but they complained fatigue and palpitation and echocardiographyc dysfunction. Left ventricular dysfunction and QRS duration at ECG were independent predictors of ventricular arrhythmias in all patients.
  
  
  CONCLUSIONS
  There were no gender-specific differences in patients operated on for TOF using ventriculotomy. Pregnancy is an event in these patients at risk for the newborn, in terms of miscarriage, prematurity, and recurrence of birth defects, and for the mother in terms of ventricular dysfunction and electrical instability. At least a single pregnancy does not appear to significantly modify the natural history of post-surgical patients operated on for TOF.
authors.affiliation: Cardiology Unit, Department of Cardiac, Thoracic and Vascular Surgery, University of Padua Medical School, Padua, Italy.
authors.forename: Luciano
authors.initials: L
authors.lastname: Daliento
authors.forename: Lucia
authors.initials: L
authors.lastname: Dal Bianco
authors.forename: Francesco
authors.initials: F
authors.lastname: Bagato
authors.forename: Eleonora
authors.initials: E
authors.lastname: Secco
authors.forename: Berardo
authors.initials: B
authors.lastname: Sarubbi
authors.forename: Elisa
authors.initials: E
authors.lastname: Mazzotti
authors.forename: Barbara
authors.initials: B
authors.lastname: Bauce
authors.forename: Giulio
authors.initials: G
authors.lastname: Rizzoli
mesh_terms: D000328:Adult; D001145:Arrhythmias, Cardiac / Q000601:surgery; D004562:Electrocardiography; D005260:Female; D006330:Heart Defects, Congenital / Q000601:surgery; D006801:Humans; D008297:Male; D008875:Middle Aged; D011247:Pregnancy; D012086:Reoperation; D012727:Sex Characteristics; D013771:Tetralogy of Fallot / Q000503:physiopathology / Q000601:surgery; D016896:Treatment Outcome