title: Reducing ionizing radiation doses during cardiac interventions in pregnant women.
abstract: BACKGROUND
  There is concern over ionizing radiation exposure in women who are pregnant or of child-bearing age. Due to the increasing prevalence of congenital and acquired heart disease, the number of women who require cardiac interventions during pregnancy has increased. We have developed protocols for cardiac interventions in pregnant women and women of child-bearing age, aimed at substantially reducing both fluoroscopy duration and radiation doses.
  
  
  METHODS
  Over five years, we performed cardiac interventions on 15 pregnant women, nine postpartum women and four as part of prepregnancy assessment. Fluoroscopy times were minimized by simultaneous use of intracardiac echocardiography, and by using very low frame rates (2/second) during fluoroscopy.
  
  
  RESULTS
  The procedures most commonly undertaken were closure of atrial septal defect (ASD) or patent foramen ovale (PFO) in 16 women, coronary angiograms in seven, right and left heart catheters in three and two stent placements. The mean screening time for all patients was 2.38 minutes (range 0.48-13.7), the median radiation dose was 66 (8.9-1501) Gy/cm(2). The median radiation dose to uterus was 1.92 (0.59-5.47) μGy, and the patient estimated dose was 0.24 (0.095-0.80) mSv.
  
  
  CONCLUSIONS
  Ionizing radiation can be used safely in the management of severe cardiac structural disease in pregnancy, with very low ionizing radiation dose to the mother and extremely low exposure to the fetus. With experience, ionizing radiation doses at our institution have been reduced.
authors: Department of Cardiology, John Radcliffe Hospital , Oxford OX3 9DU , UK.
authors: Elizabeth
authors: E
authors: Orchard
authors: Department of Cardiology, John Radcliffe Hospital , Oxford OX3 9DU , UK.
authors: Sarah
authors: S
authors: Dix
authors: Department of Cardiology, John Radcliffe Hospital , Oxford OX3 9DU , UK.
authors: Neil
authors: N
authors: Wilson
authors: Department of Cardiology, John Radcliffe Hospital , Oxford OX3 9DU , UK.
authors: Lucy
authors: L
authors: Mackillop
authors: Department of Cardiology, John Radcliffe Hospital , Oxford OX3 9DU , UK.
authors: Oliver
authors: O
authors: Ormerod
keywords: cardiology