title: Impact of pregnancy on the cardiac health of women with prior surgeries for pulmonary valve anomalies.
abstract: OBJECTIVE
  We assessed the impact of pregnancy on long-term cardiac outcomes in women with prior surgery for congenital pulmonary valve anomalies.
  
  
  METHODS
  Data on all reproductive age women with prior pulmonary valve repair or replacement, cared for at a tertiary institution over a 10-year period, were analyzed. Kaplan-Meier curves and proportional hazards models were estimated to assess the impact of pregnancy and multiparity on a composite long-term adverse outcome defined as death, heart failure, or unanticipated cardiac surgery. Peripartum cardiac complications were also assessed.
  
  
  RESULTS
  Thirty-three parous and 20 nulliparous, nonpregnant controls with primary pulmonary valve replacement or repair were identified. Among the parous women, there were 95 pregnancies (median, 3.0; 1-10) resulting in 81 live births. Peripartum cardiac complications occurred in 28 (29.8%; 95% confidence interval, 20.4-39.2) of the pregnancies. A composite adverse long-term cardiac outcome occurred in 17 of 33 parous women, over 417 person-years (4 per 100 person-years) and 1 of 20 nulliparous women over 258 person-years (0.4 per 100 person-years); women with pregnancies were more likely at any point in time to have a composite long-term adverse cardiac outcome compared with nulliparous controls. Women with 2 or more pregnancies were more likely to have a composite adverse cardiac outcome than those with less than 2 pregnancies (hazard ratio, 8.8; 95% confidence interval, 1.5-50.3).
  
  
  CONCLUSIONS
  Peripartum cardiac complications are common in women with prior pulmonary valve repair or replacement. Pregnancy appears to increase the risk of long-term adverse cardiac outcomes in these patients when compared with nulliparous controls.
authors.affiliation: Department of Obstetrics and Gynecology, University of Utah School of Medicine, Salt Lake City, UT.
authors.forename: Torri D
authors.initials: TD
authors.lastname: Metz
authors.forename: Sammy A
authors.initials: SA
authors.lastname: Hayes
authors.forename: Clarisa Y
authors.initials: CY
authors.lastname: Garcia
authors.forename: Anji T
authors.initials: AT
authors.lastname: Yetman
mesh_terms: D000328:Adult; D058385:Cardiac Valve Annuloplasty; D016022:Case-Control Studies; D004697:Endocarditis, Bacterial / Q000150:complications; D005260:Female; D006333:Heart Failure / Q000150:complications; D019918:Heart Valve Prosthesis Implantation; D006801:Humans; D011247:Pregnancy; D011249:Pregnancy Complications, Cardiovascular; D011251:Pregnancy Complications, Infectious; D011655:Pulmonary Embolism / Q000150:complications; D011664:Pulmonary Valve / Q000601:surgery*; D011666:Pulmonary Valve Stenosis / Q000150:complications / Q000151:congenital / Q000601:surgery*; D012189:Retrospective Studies; D012307:Risk Factors; D013771:Tetralogy of Fallot / Q000150:complications / Q000601:surgery*; D055815:Young Adult
keywords: cardiac outcomes; maternal congenital heart disease; multiparity; pulmonary stenosis; tetralogy of Fallot