Pregnancy and Right-Sided Allograft Reconstruction

Study Questions:

What are the pregnancy outcomes among women with right ventricular outflow tract (RVOT) reconstruction?

Methods:

This was a retrospective cohort study of women who received an allograft in the RVOT position at Erasmus Medical Center from 1986-2017. Completed pregnancies (>20 weeks gestation) were screened for cardiac, obstetric, and fetal outcomes.

Results:

Of 196 women, information on 84 pregnancies was available, with mean maternal age 29.6 ± 4.3 years, 95.2% in New York Heart Association (NYHA) class I/II, and 44.2% with diagnosis of tetralogy of Fallot. Median time from allograft-implantation was 6.7 years. Maternal complications included heart failure (2.4%), infection/chorioamnionitis (1.2%), and pre-eclampsia (3.6%). There were no maternal deaths. Fetal complications included small for gestational age (20.2%) and prematurity (23.8%), and were significantly higher than in the general Dutch population. There were two neonatal deaths (2.5%). Pulmonary regurgitation was associated with pre-term labor (odds ratio, 2.61; 95% confidence interval, 1.32-5.17).

Conclusions:

Pregnancy may be well-tolerated in women after RVOT reconstruction, who are in good clinical condition; however, the rate of preterm delivery and children small for gestational age is increased. Significant pulmonary regurgitation is associated with preterm labor.

Perspective:

Although this study provides reassurance that women with RVOT allograft can pursue pregnancy with low risk of maternal and obstetric complications, several issues should be considered. First, the majority of women in this study were clinically stable, NYHA class I/II, and all were followed at a tertiary care center with expertise in congenital heart disease. Second, the potential effects of prematurity and growth restriction on the health of the fetus need to be discussed during preconception counseling. Third, the impact of pregnancy on the long-term functioning of the allograft remains unclear and requires further research.

Clinical Topics: Congenital Heart Disease and Pediatric Cardiology, Heart Failure and Cardiomyopathies, Valvular Heart Disease, Congenital Heart Disease, CHD and Pediatrics and Quality Improvement, Acute Heart Failure

Keywords: Allografts, Chorioamnionitis, Fetus, Gestational Age, Heart Defects, Congenital, Heart Failure, Infant, Newborn, Maternal Age, Obstetric Labor, Premature, Pre-Eclampsia, Pregnancy, Pregnancy Outcome, Prenatal Care, Pulmonary Valve Insufficiency, Tertiary Care Centers, Tetralogy of Fallot, Women


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