title: Risk factors for maternal and fetal outcome in pregnancy complicated by Ebstein anomaly.
abstract: OBJECTIVE
  The goal of the study was to examine risks in pregnancy in patients with Ebstein anomaly.
  
  
  METHODS
  Data were examined retrospectively for 13 patients (27 pregnancies, 21 live births) with Ebstein anomaly during pregnancy who were treated at our institution from 1985 to 2011. The associated anomalies in these patients were atrial septal defect (ASD) (n = 4) and the Wolff-Parkinson-White syndrome (n = 6).
  
  
  RESULTS
  Before pregnancy, 2 patients underwent ASD closure and 1 received tricuspid valve replacement (TVR). In all patients, the cardiothoracic ratio increased from 55.1 at conception to 57.0 during pregnancy and 58.0 postpartum (P < .05). Cesarean sections were performed in 3 cases: 1 with ventricular tachycardia and orthopnea (New York Heart Association [NYHA] III) preterm; at full term, and the third in a patient with a mechanical tricuspid valve who developed maternal cerebellum hemorrhage at 27 weeks. The baby died of prematurity in the third case. In all other cases (20 of 21), neonatal prognoses were good without congenital heart diseases. There were 6 spontaneous abortions. Recurrent paroxysmal supraventricular tachycardia occurred during pregnancy in 2 cases and was treated with adenosine triphosphate or verapamil. In 17 pregnancies, NYHA remained in class I and all had full-term vaginal delivery.
  
  
  CONCLUSIONS
  Maternal and fetal outcomes are good in patients with Ebstein anomaly and NYHA class I. However, pregnancy in Ebstein anomaly can be complicated with tachyarrhythmia or cardiac failure. In post-TVR cases, meticulous care is required for these complications during pregnancy and delivery.
authors.affiliation: Department of Perinatology and Gynecology, National Cerebral and Cardiovascular Center, Osaka, Japan. Electronic address: skatsura12@yahoo.co.jp.
authors.forename: Shinji
authors.initials: S
authors.lastname: Katsuragi
authors.forename: Chizuko
authors.initials: C
authors.lastname: Kamiya
authors.forename: Kaoru
authors.initials: K
authors.lastname: Yamanaka
authors.forename: Reiko
authors.initials: R
authors.lastname: Neki
authors.forename: Takekazu
authors.initials: T
authors.lastname: Miyoshi
authors.forename: Naoko
authors.initials: N
authors.lastname: Iwanaga
authors.forename: Chinami
authors.initials: C
authors.lastname: Horiuchi
authors.forename: Hiroaki
authors.initials: H
authors.lastname: Tanaka
authors.forename: Jun
authors.initials: J
authors.lastname: Yoshimatsu
authors.forename: Koichiro
authors.initials: K
authors.lastname: Niwa
authors.forename: Tomoaki
authors.initials: T
authors.lastname: Ikeda
mesh_terms: D000022:Abortion, Spontaneous; D000328:Adult; D002585:Cesarean Section; D015331:Cohort Studies; D004437:Ebstein Anomaly / Q000150:complications*; D005260:Female; D006344:Heart Septal Defects, Atrial / Q000150:complications* / Q000601:surgery; D006801:Humans; D011247:Pregnancy; D011249:Pregnancy Complications, Cardiovascular; D011256:Pregnancy Outcome; D047928:Premature Birth; D012189:Retrospective Studies; D012307:Risk Factors; D016896:Treatment Outcome; D014261:Tricuspid Valve / Q000601:surgery; D014927:Wolff-Parkinson-White Syndrome / Q000150:complications* / Q000628:therapy
keywords: Ebstein anomaly; New York Heart Association; arrhythmia; cardiac function; pregnancy